title: Is single-operator peroral cholangioscopy a useful tool for the diagnosis of indeterminate biliary lesion? A systematic review and meta-analysis.
abstract: BACKGROUND
  Differentiating between malignant and benign biliary lesions is critical in clinical practice but is difficult.
  
  
  OBJECTIVE
  To systematically evaluate the diagnostic performance of single-operator peroral cholangioscopy on indeterminate biliary lesions.
  
  
  METHODS
  A systematic review and meta-analysis.
  
  
  METHODS
  Patients with indeterminate biliary lesions or equivocal ERCP findings.
  
  
  METHODS
  The diagnostic performance of single-operator peroral cholangioscopy on indeterminate biliary lesions. The area under the summary receiver-operating characteristic curve was used as the main indicator for the overall diagnostic performance of single-operator peroral cholangioscopy visual impression (VI) and SpyBite biopsy (SB). The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were also synthesized.
  
  
  RESULTS
  A total of 8 studies met the inclusion criteria, involving 335 patients who had data on VI and 337 who had data on SB. The area under the curve values on the summary receiver-operating characteristic curve of single-operator peroral cholangioscopy VI and SB were 0.94 (95% confidence interval [CI], 0.92-0.96) and 0.93 (95% CI, 0.90-0.95) respectively. The combined sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were 90% (95% CI, 73%-97%), 87% (95% CI, 76%-94%), 7.1 (95% CI, 3.8-13.3), 0.12 (95% CI, 0.04-0.33) for VI and 69% (95% CI, 57%-79%), 98% (95% CI, 92%-99%), 30.1 (95% CI, 8.5-106.9), and 0.32 (95% CI, 0.23-0.44) for SB, respectively.
  
  
  CONCLUSIONS
  Small number of included studies; comparison with ERCP could not be made.
  
  
  CONCLUSIONS
  Single-operator peroral cholangioscopy is a good tool for differentiating malignant and benign biliary lesions. VI is useful for detecting malignant lesion, whereas SB is better at confirming a malignant diagnosis, but VI is not perfect in excluding biliary cancer, nor is SB, and their negative results should be interpreted with caution.
authors.affiliation: Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China; Nanlou Digestive Endoscopy Center, Chinese PLA General Hospital, Beijing, China.
authors.forename: Xi
authors.initials: X
authors.lastname: Sun
authors.affiliation: Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: Zhirui
authors.initials: Z
authors.lastname: Zhou
authors.affiliation: St. Vincent Hospital, Indianapolis, Indiana, USA.
authors.forename: Jianmin
authors.initials: J
authors.lastname: Tian
authors.affiliation: Nanlou Digestive Endoscopy Center, Chinese PLA General Hospital, Beijing, China.
authors.forename: Zhiqiang
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China.
authors.forename: Qiyang
authors.initials: Q
authors.lastname: Huang
authors.affiliation: Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China.
authors.forename: Kaichun
authors.initials: K
authors.lastname: Fan
authors.affiliation: Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China.
authors.forename: Yongping
authors.initials: Y
authors.lastname: Mao
authors.affiliation: Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China.
authors.forename: Gang
authors.initials: G
authors.lastname: Sun
authors.affiliation: Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China.
authors.forename: Yunsheng
authors.initials: Y
authors.lastname: Yang
mesh_terms: D001649:Bile Duct Diseases / Q000175:diagnosis*; D001650:Bile Duct Neoplasms / Q000175:diagnosis; D003937:Diagnosis, Differential; D016145:Endoscopy, Digestive System / Q000379:methods*; D006801:Humans; D012680:Sensitivity and Specificity