title: Identification of cholangiocarcinoma by using the Spyglass Spyscope system for peroral cholangioscopy and biopsy collection.
abstract: OBJECTIVE
  It is a challenge to collect samples from bile duct strictures to diagnose patients with cholangiocarcinoma. We investigated the utility of the Spyglass Spyscope, a single-operator endoscope that is used to perform cholangiopancreatoscopy, to identify extrahepatic cholangiocarcinoma in patients who were not diagnosed with this disorder by endoscopic retrograde cholangiopancreatography (ERCP) cytology or endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) analyses.
  
  
  METHODS
  We conducted a retrospective analysis of data from 30 patients (median age, 67 years; 67% male) with indeterminate extrahepatic biliary strictures who were ultimately diagnosed with cholangiocarcinoma but had inconclusive results from initial biliary ductal brush cytology and EUS-FNA analyses. Patients then underwent cholangioscopy by using the Spyglass Spyscope and intraductal biopsy analysis. None of the patients had a definitive mass in abdominal imaging or EUS analyses.
  
  
  RESULTS
  The biliary stricture was located in the common bile duct in 13 patients and in the common hepatic duct in 17 patients. The Spyglass Spyscope system had 77% accuracy (23 of 30) in the diagnosis of malignancies that were inconclusive on the basis of ERCP-guided brush or EUS-FNA analyses.
  
  
  CONCLUSIONS
  The Spyglass Spyscope for cholangioscopy and biopsy collection identified malignancies with 77% accuracy in patients with suspected cholangiocarcinoma.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA. ali.siddiqui@jefferson.edu
authors.forename: Ali A
authors.initials: AA
authors.lastname: Siddiqui
authors.forename: Vaibhav
authors.initials: V
authors.lastname: Mehendiratta
authors.forename: Whitney
authors.initials: W
authors.lastname: Jackson
authors.forename: David E
authors.initials: DE
authors.lastname: Loren
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Kowalski
authors.forename: Mohamad A
authors.initials: MA
authors.lastname: Eloubeidi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000379:methods; D018281:Cholangiocarcinoma / Q000175:diagnosis* / Q000473:pathology*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies