title: Role of balloon-assisted cholangioscopy in a multiethnic cohort to assess complex biliary disease (with videos).
abstract: BACKGROUND
  Cholangioscopy is used to diagnose and treat various biliary lesions. Balloon-assisted cholangioscopy (BAC) has mostly been reported in Asian patients with large bile ducts.
  
  
  OBJECTIVE
  To assess the feasibility and accuracy of performing BAC in complex biliary diseases in Australian patients.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  A single Australian tertiary referral hospital.
  
  
  METHODS
  Fifty-nine consecutive patients (55 non-Asian ethnicity).
  
  
  METHODS
  BAC using ultrathin endoscopes.
  
  
  METHODS
  Procedural success rates, diagnostic accuracy, and adverse event rates.
  
  
  RESULTS
  Fifty-nine patients underwent 76 BAC procedures for indeterminate biliary lesions, ampullary adenomas, and difficult stone disease. The technical success rate was 93%. The median bile duct diameter was 7 mm (range, 2-20). Of 34 indeterminate biliary strictures, 22 appeared benign and 12 malignant on BAC appearance alone. All benign-appearing strictures were confirmed benign, whereas 9 of 12 malignant-appearing strictures were confirmed malignant by biopsy sampling or follow-up (sensitivity 100% [95% CI, 66%-100%], specificity 88% [95% CI, 69%-97%], positive predictive value 75% [95% CI, 42%-93%], negative predictive value 100% [95% CI, 82%-100%]). BAC appearance correctly diagnosed indeterminate masses as benign (4/4) or malignant (3/3). Eight patients were assessed for bile duct extension of ampullary adenomas and 5 of 6 had biliary stones cleared directly or with holmium laser lithotripsy. Adequate histopathologic specimens were obtained from 31 of 39 (79%) attempted biopsy specimens. The adverse event rate was 8%.
  
  
  CONCLUSIONS
  A single-center, single endoscopist experience.
  
  
  CONCLUSIONS
  In a largely non-Asian cohort with smaller bile ducts, BAC can be performed with high success and acceptable adverse event rates. BAC is particularly useful in differentiating benign from malignant indeterminate biliary lesions.
authors.affiliation: Department of Gastroenterology and Hepatology, St George Hospital, Sydney, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Lim
authors.affiliation: Department of Gastroenterology and Hepatology, St George Hospital, Sydney, Australia.
authors.forename: Vipul
authors.initials: V
authors.lastname: Aggarwal
authors.affiliation: Department of Gastroenterology and Hepatology, St George Hospital, Sydney, Australia; St George Clinical School, University of New South Wales, Sydney, Australia.
authors.forename: Philip
authors.initials: P
authors.lastname: Craig
mesh_terms: D000236:Adenoma / Q000150:complications / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D002769:Cholelithiasis / Q000175:diagnosis / Q000628:therapy; D003135:Common Bile Duct / Q000473:pathology*; D003138:Common Bile Duct Neoplasms / Q000150:complications / Q000473:pathology*; D003251:Constriction, Pathologic / Q000209:etiology; D016145:Endoscopy, Digestive System / Q000009:adverse effects / Q000295:instrumentation*; D005006:Ethnicity; D005260:Female; D006801:Humans; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies