title: Diagnostic and therapeutic utility of single-operator peroral cholangioscopy for indeterminate biliary lesions and bile duct stones.
abstract: OBJECTIVE
  We aimed to evaluate the diagnostic utility of single-operator peroral cholangioscopy (SOC) for indeterminate biliary lesions and its usefulness in electrohydraulic lithotripsy (EHL) of biliary stones not amenable to conventional endoscopic therapy.
  
  
  METHODS
  All patients undergoing SpyGlass SOC in four UK tertiary centres between 2008 and 2010 were retrospectively enrolled. Patients were followed up until death or the last clinic visit until May 2011. The operating characteristics of SOC for detecting malignant lesions and the stone clearance rate after SOC-guided EHL were calculated.
  
  
  RESULTS
  A total of 165 patients underwent 179 SOC procedures. Sixty-six percent were referred for indeterminate biliary strictures, 13% for filling defects and 21% for SOC-guided EHL. Cannulation with the SOC system was successful in 95% but visualization was inadequate in 13%. Primary sclerosing cholangitis was a risk factor for failed cannulation and conscious sedation (vs. general anaesthesia) for inadequate visualization (P<0.05). The accuracy of SOC for diagnosing malignant lesions was 87%. SOC-guided biopsies were adequate in 72%. Obtaining at least four versus less than four biopsy specimens resulted more often in adequate samples (90 vs. 64%, P=0.037). Complete stone clearance could be achieved in 73% of patients. The adverse event rate was 9.6%. Cholangitis was the most common event (56%, one fatal).
  
  
  CONCLUSIONS
  SOC is useful for the differential diagnosis of indeterminate biliary lesions and the treatment of 'difficult' biliary stones. The adequacy of SOC-guided biopsies is related to the number of specimens obtained. Primary sclerosing cholangitis is related to failed cannulation with the SOC system, whereas general anaesthesia is related to adequate visualization.
authors.affiliation: Digestive Diseases Unit, Aintree University Hospital, Liverpool, UK.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Kalaitzakis
authors.forename: George J
authors.initials: GJ
authors.lastname: Webster
authors.forename: Kofi W
authors.initials: KW
authors.lastname: Oppong
authors.forename: Yiannis
authors.initials: Y
authors.lastname: Kallis
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Vlavianos
authors.forename: Matthew
authors.initials: M
authors.lastname: Huggett
authors.forename: Muhammad F
authors.initials: MF
authors.lastname: Dawwas
authors.forename: Venkata
authors.initials: V
authors.lastname: Lekharaju
authors.forename: Adrian
authors.initials: A
authors.lastname: Hatfield
authors.forename: David
authors.initials: D
authors.lastname: Westaby
authors.forename: Richard
authors.initials: R
authors.lastname: Sturgess
mesh_terms: D000368:Aged; D001649:Bile Duct Diseases / Q000175:diagnosis* / Q000601:surgery; D001650:Bile Duct Neoplasms / Q000175:diagnosis / Q000601:surgery; D001653:Bile Ducts, Intrahepatic; D001706:Biopsy / Q000379:methods; D018281:Cholangiocarcinoma / Q000175:diagnosis / Q000601:surgery; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002769:Cholelithiasis / Q000175:diagnosis / Q000601:surgery; D003937:Diagnosis, Differential; D016145:Endoscopy, Digestive System / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008096:Lithotripsy / Q000379:methods; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome