UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Medline ® Abstract for Reference 74

of 'Cholangioscopy and pancreatoscopy'

74
TI
Is single-operator peroral cholangioscopy a useful tool for the diagnosis of indeterminate biliary lesion? A systematic review and meta-analysis.
AU
Sun X, Zhou Z, Tian J, Wang Z, Huang Q, Fan K, Mao Y, Sun G, Yang Y
SO
Gastrointest Endosc. 2015 Jul;82(1):79-87. Epub 2015 Apr 1.
 
BACKGROUND: Differentiating between malignant and benign biliary lesions is critical in clinical practice but is difficult.
OBJECTIVE: To systematically evaluate the diagnostic performance of single-operator peroral cholangioscopy on indeterminate biliary lesions.
DESIGN: A systematic review and meta-analysis.
PATIENTS: Patients with indeterminate biliary lesions or equivocal ERCP findings.
MAIN OUTCOME MEASUREMENTS: The diagnostic performance of single-operator peroral cholangioscopy on indeterminate biliary lesions. The area under the summary receiver-operating characteristic curve was used as the main indicator for the overall diagnostic performance of single-operator peroral cholangioscopyvisual impression (VI) and SpyBite biopsy (SB). The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were also synthesized.
RESULTS: A total of 8 studies met the inclusion criteria, involving 335 patients who had data on VI and 337 who had data on SB. The area under the curve values on the summary receiver-operating characteristic curve of single-operator peroral cholangioscopy VI and SB were 0.94 (95% confidence interval [CI], 0.92-0.96) and 0.93 (95% CI, 0.90-0.95) respectively. The combined sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were 90% (95% CI, 73%-97%), 87% (95% CI, 76%-94%), 7.1 (95% CI, 3.8-13.3), 0.12 (95% CI, 0.04-0.33) for VI and 69% (95% CI, 57%-79%), 98% (95% CI, 92%-99%), 30.1 (95% CI, 8.5-106.9), and 0.32 (95% CI, 0.23-0.44) for SB, respectively.
LIMITATIONS: Small number of included studies; comparison with ERCP could not be made.
CONCLUSION: Single-operator peroral cholangioscopy is a good tool for differentiating malignant and benign biliary lesions. VI is useful for detecting malignant lesion, whereas SB is better at confirming a malignant diagnosis, but VI is not perfect in excluding biliary cancer, nor is SB, and their negative results should be interpreted with caution.
AD
Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China; Nanlou Digestive Endoscopy Center, Chinese PLA General Hospital, Beijing, China.
PMID