title: Prospective evaluation of the short access cholangioscopy for stone clearance and evaluation of indeterminate strictures.
abstract: BACKGROUND
  Peroral cholangioscopy facilitates diagnosis and therapy of biliary disorders. This study prospectively evaluated a new short access cholangioscopy.
  
  
  METHODS
  Consecutive patients were included as follows: difficult stones (group 1) underwent cholangioscopy with electrohydraulic lithotripsy and indeterminate biliary strictures (group 2) were evaluated with macroscopic assessment and cholangioscopy guided biopsy sampling. We evaluated the complete stone clearance rate (group 1) and diagnostic accuracy (group 2). Follow-up was performed over a median of 13 and 16 months, respectively.
  
  
  RESULTS
  Group 1 (n=21): complete stone clearance defined as lack of stones in cholangiography and stone removal during cholangioscopy was achieved in 15 (71.4%) patients. Clinical stone clearance defined as lack of symptoms, laboratory abnormalities and hospital visits during follow-up, irrespective of stone clearance was evident in 17 (81.0%) patients. One serious adverse event occurred (bile duct perforation). Group 2 (n=28): malignancy was confirmed in 15 patients. Sensitivity, specificity and diagnostic accuracy of cholangioscopy were 85.7%, 75.0% and 80.7%, respectively. Sensitivity, specificity and diagnostic accuracy of biopsies were 54.5%, 100.0% and 72.2%, respectively. No serious adverse events occurred, and one patient was lost to follow-up.
  
  
  CONCLUSIONS
  The novel system enabled complex stone treatment and biliary stricture diagnosis. Cholangioscopy outperformed direct biopsy regarding characterization of indeterminate strictures.
authors.affiliation: Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Martinistra?e 52, 20246, Hamburg, Germany. u.denzer@uke.de.
authors.forename: Athanasios D
authors.initials: AD
authors.lastname: Sioulas
authors.forename: Muhammad A
authors.initials: MA
authors.lastname: El-Masry
authors.forename: Stefan
authors.initials: S
authors.lastname: Groth
authors.forename: Guido
authors.initials: G
authors.lastname: Schachschal
authors.forename: Mario
authors.initials: M
authors.lastname: Anders
authors.forename: Thomas
authors.initials: T
authors.lastname: Rosch
authors.forename: Ulrike
authors.initials: U
authors.lastname: Denzer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001652:Bile Ducts / Q000000981:diagnostic imaging* / Q000473:pathology; D001706:Biopsy; D002779:Cholestasis / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy*; D003251:Constriction, Pathologic; D019723:Endoscopes; D016145:Endoscopy, Digestive System / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D042882:Gallstones / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy*; D005858:Germany; D006801:Humans; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D013997:Time Factors; D016896:Treatment Outcome