title: Diagnostic utility of single-user peroral cholangioscopy in sclerosing cholangitis.
abstract: OBJECTIVE
  To evaluate the diagnostic utility of single-operator peroral cholangioscopy (SOC) in patients with sclerosing cholangitis.
  
  
  METHODS
  All patients with sclerosing cholangitis who underwent SOC procedures due to suspicious biliary strictures, in one Swedish and four UK tertiary centers in 2008-2012, were retrospectively enrolled. For each SOC procedure in sclerosing cholangitis, another one attempted due to a single biliary stricture in the same center and calendar year was randomly selected as control. Patients were followed up until death or last clinic visit until November 2012.
  
  
  RESULTS
  Fifty-four SOC procedures were attempted in 52 sclerosing cholangitis patients (48 with primary sclerosing cholangitis, 4 with IgG4-related sclerosing cholangitis). Cannulation with the SOC system failed more frequently in sclerosing cholangitis (15% vs. 2% in controls; p = 0.015). The sensitivity, specificity, and accuracy of SOC (including tissue sampling) for cancer diagnosis were similar in sclerosing cholangitis and controls (50% vs. 55%, 100% vs. 97%, and 88% vs. 80%, respectively) with largely overlapping confidence intervals. Adverse events were more common in sclerosing cholangitis, due to an increased frequency of cholangitis (11% vs. 2% in controls; p = 0.051).
  
  
  CONCLUSIONS
  SOC is equally accurate in cancer diagnosis in sclerosing cholangitis and patients with single biliary strictures. However, cholangioscope insertion may be hampered by bile duct narrowing and post-SOC cholangitis is more common in sclerosing cholangitis.
authors.affiliation: Department of Gastroenterology, Skåne University Hospital , Lund , Sweden.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Kalaitzakis
authors.forename: Richard
authors.initials: R
authors.lastname: Sturgess
authors.forename: Harry
authors.initials: H
authors.lastname: Kaltsidis
authors.forename: Kofi
authors.initials: K
authors.lastname: Oppong
authors.forename: Venkata
authors.initials: V
authors.lastname: Lekharaju
authors.forename: Per
authors.initials: P
authors.lastname: Bergenzaun
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Vlavianos
authors.forename: Hemant
authors.initials: H
authors.lastname: Sharma
authors.forename: David
authors.initials: D
authors.lastname: Westaby
authors.forename: George J
authors.initials: GJ
authors.lastname: Webster
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D001652:Bile Ducts; D001706:Biopsy; D016022:Case-Control Studies; D002404:Catheterization; D015209:Cholangitis, Sclerosing / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D003251:Constriction, Pathologic / Q000209:etiology; D016145:Endoscopy, Digestive System / Q000009:adverse effects / Q000379:methods*; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009055:Mouth; D011237:Predictive Value of Tests; D012189:Retrospective Studies
keywords: IgG4-related sclerosing cholangitis; cholangiocarcinoma; cholangioscopy; endoscopic retrograde cholangiopancreatography; primary sclerosing cholangitis