title: Diagnostic peroral video cholangioscopy is an accurate diagnostic tool for patients with bile duct lesions.
abstract: OBJECTIVE
  We evaluated the diagnostic ability of a newly developed peroral video cholangioscopy (PVCS) in patients with pancreaticobiliary disorders.
  
  
  METHODS
  We retrospectively evaluated data from 144 patients with pancreaticobiliary disorders, collected from 5 tertiary referral centers. Endoscopic sphincterotomy (EST) or endoscopic papillary balloon dilation (EPBD) was performed before PVCS. We performed 2 types of PVCS, using a conventional therapeutic duodenoscope. If tissue samples were needed, cholangioscopy-assisted biopsy or fluoroscopy-guided biopsy was performed.
  
  
  RESULTS
  PVCS was advanced into the bile duct in all cases after patients received EST (n = 134 cases), EPBD (n = 2), a combination of EST and EPBD (n = 1), or without treatment of the major papilla (n = 7). Biopsy samples were collected successfully from 112 of 120 cases in which endoscopists considered tissue sampling necessary. Endoscopic retrograde cholangiopancreatography (ERCP)/biopsy correctly identified 83 of 96 malignant lesions and 19 of 24 benign lesions (accuracy = 85.0%; sensitivity = 86.5%; specificity = 79.2%; positive predictive value = 94.3%; negative predictive value = 59.4%). Endoscopic retrograde cholangiopancreatography (ERCP)/biopsy plus PVCS correctly identified 95 of 96 malignant lesions and 23 of 24 benign lesions (accuracy = 98.3%; sensitivity = 99.0%; specificity = 95.8%; positive predictive value = 99.0%; negative predictive value = 95.8%). Procedure-related complications included pancreatitis (4 cases, 2.8%) and cholangitis (6 cases, 4.3%).
  
  
  CONCLUSIONS
  PVCS is an accurate diagnostic tool for patients with pancreaticobiliary disorders; resolution was well-defined when combined with biopsy analysis. Prospective multicenter clinical trials should evaluate the clinical utility of PVCS in diagnosis of biliary tract diseases.
authors.affiliation: Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan. itoi@tokyo-med.ac.jp
authors.forename: Takao
authors.initials: T
authors.lastname: Itoi
authors.forename: Manabu
authors.initials: M
authors.lastname: Osanai
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Igarashi
authors.forename: Kiyohito
authors.initials: K
authors.lastname: Tanaka
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Kida
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Maguchi
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Yasuda
authors.forename: Naoki
authors.initials: N
authors.lastname: Okano
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Imaizumi
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Yokoyama
authors.forename: Fumihide
authors.initials: F
authors.lastname: Itokawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001649:Bile Duct Diseases / Q000175:diagnosis*; D001652:Bile Ducts / Q000473:pathology*; D001706:Biopsy; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004384:Duodenoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity