Skip to main content
SpringerLink
Log in

ERCP with Probe-Based Confocal Laser Endomicroscopy for the Evaluation of Dominant Biliary Stenoses in Primary Sclerosing Cholangitis Patients

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background and Study Aim

The incidence of cholangiocarcinoma (CCA) in primary sclerosing cholangitis (PSC) ranges between 7 and 14 %. Despite using multiple tissue sampling modalities, detection of CCA remains a challenge. Probe-based confocal laser endomicroscopy (pCLE) has been utilized to visualize subepithelial biliary mucosa in patients with indeterminate strictures. We assessed the technical feasibility and operating characteristics of pCLE in a cohort of PSC patients with dominant biliary strictures (DS).

Patients and Methods

This was a chart review of a prospectively maintained database at a single tertiary referral center of 15 PSC patients with 21 dominant stenoses undergoing pCLE. A data collection sheet included demographics, ERCP, cholangioscopy, pCLE (Miami criteria), tissue sampling results, and follow-up to 12 months or liver transplantation. Operating characteristics for pCLE and ERCP tissue sampling were calculated.

Results

Sufficient visualization of DS by pCLE was achieved in 20/21 (95 %). pCLE sensitivity, specificity, PPV, and NPV were 100 % (95 % CI 19.3–100 %), 61.1 % (95 % CI 35.8–82.6 %), 22.2 % (95 % CI 3.5–59.9 %), and 100 % (95 % CI 71.3–100 %), respectively, in detecting neoplasia. In comparison, concomitant tissue sampling yielded sensitivity, specificity, PPV, and NPV of 0 % (95 % CI 0–80.7 %), 94.4 % (95 % CI 72.6–99.1 %), 0 % (95 % CI 0–83.5 %), and 89.5 % (95 % CI 66.8–98.4 %), respectively.

Conclusions

pCLE achieves a high technical success rate in patients with PSC and DS. This single center, small series, suggests that pCLE may have a high sensitivity and negative predictive value to exclude neoplasia. If verified in larger prospective studies, the technology may be utilized to risk stratify dominant strictures in patients with PSC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Abbreviations

CCA:

Cholangiocarcinoma

DS:

Dominant biliary stricture

PPV:

Positive predictive value

PSC:

Primary sclerosing cholangitis

pCLE:

Probe-based confocal laser endomicroscopy

NPV:

Negative predictive value

References

  1. Boberg K, Lind G. Primary sclerosing cholangitis and malignancy. Best Pract Res Clin Gastroenterol. 2011;25:753–764.

    Article  PubMed  Google Scholar 

  2. Rösch T, Hofrichter K, Frimberger E, et al. ERCP or EUS for tissue diagnosis of biliary strictures? A prospective comparative study. Gastrointest Endosc. 2004;60:390–396.

    Article  PubMed  Google Scholar 

  3. Ponchon T, Gagnon P, Berger F, et al. Value of endobiliary brush cytology and biopsies for the diagnosis of malignant bile duct stenosis: results of a prospective study. Gastrointest Endosc. 1995;42:565–572.

    Article  PubMed  CAS  Google Scholar 

  4. Schöfl R, Haefner M, Wrba F, et al. Forceps biopsy and brush cytology during endoscopic retrograde cholangiopancreatography for the diagnosis of biliary stenoses. Scand J Gastroenterol. 1997;32:363–368.

    Article  Google Scholar 

  5. Bangarulingam SY, Bjornsson E, Enders F, et al. Long-term outcomes of positive fluorescence in situ hybridization tests in primary sclerosing cholangitis. Hepatology. 2010;51:174–180.

    Article  PubMed  CAS  Google Scholar 

  6. Barr Fritcher EG, Kipp BR, Voss JS, et al. Primary sclerosing cholangitis patients with serial polysomy fluorescence in situ hybridization results are at increased risk of cholangiocarcinoma. Am J Gastroenterol. 2011;106:2023–2028.

    Article  PubMed  Google Scholar 

  7. Awadallah NS, Chen YK, Piraka C, et al. Is there a role for cholangioscopy in patients with primary sclerosing cholangitis? Am J Gastroenterol. 2006;101:284–291.

    Article  PubMed  Google Scholar 

  8. Meining A, Chen YK, Pleskow D, et al. Direct visualization of indeterminate pancreatobiliary strictures with probe based confocal laser endomicroscopy: a multicenter experience. Gastrointest Endosc. 2011;74:961–968.

    Article  PubMed  Google Scholar 

  9. Meining A, Shah RJ, Slivka A, et al. Classification of probe-based confocal laser endomicroscopy findings in pancreaticobiliary strictures. Endoscopy. 2012;44:251–257.

    Article  PubMed  CAS  Google Scholar 

  10. Burak K, Angulo P, Pasha TM, et al. Incidence and risk factors for cholangiocarcinoma in primary sclerosing cholangitis. Am J Gastroenterol. 2004;99:523–526.

    Article  PubMed  Google Scholar 

  11. Rosen CB, Nagorney DM. Cholangiocarcinoma complicating primary sclerosing cholangitis. Semin Liver Dis. 1991;11:26–30.

    Article  PubMed  CAS  Google Scholar 

  12. Razumilava N, Gores G. Cancer surveillance in patients with primary sclerosing cholangitis. Hepatology. 2011;54:1842–1852.

    Article  PubMed  Google Scholar 

  13. Khan SA, Thomas HC, Davidson BR, et al. Cholangiocarcinoma. Lancet. 2005;366:1303–1314.

    Article  PubMed  Google Scholar 

  14. Ahrendt SA, Nakeeb A, Pitt HA. Cholangiocarcinoma. Clin Liver Dis. 2001;5:191–218.

    Article  PubMed  CAS  Google Scholar 

  15. Rudolph G, Gotthardt D, Kloeters-Plachky P, et al. In PSC with dominant bile duct stenosis, IBD is associated with an increase of carcinomas and reduced survival. J Hepatol. 2010;53:313–317.

    Article  PubMed  Google Scholar 

  16. Chen YK, Pleskow DK. SpyGlass single-operator peroral cholangiopancreatoscopy system for the diagnosis and therapy of bile-duct disorders: a clinical feasibility study (with video). Gastrointest Endosc. 2007;65:832–841.

    Article  PubMed  Google Scholar 

  17. Caillol F, Filoche B, Gaidhane M, Kahaleh M. Refined probe-based confocal laser endomicroscopy classification for biliary strictures: the Paris Classification. Dig Dis Sci. 2013;2533–2535. doi:10.1007/s10620-012-2533-5.

  18. Giovannini M, Bories E, Monges G, et al. Results of a phase I-II study on intraductal confocal microscopy (IDCM) in patients with common bile duct (CBD) stenosis. Surg Endosc. 2011;25:2247–2253.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors wish to express our deepest appreciation for the invaluable contributions to this series of our former mentor and colleague Yang K. Chen, MD. His pioneering work in the area of biliary imaging remains an inspiration and benchmark for our own aspirations.

Conflict of interest

Dr. Shah is a consultant for Cook Endoscopy and Boston Scientific, Inc. and has received unrestricted educational grants from Mauna Kea Technologies, Inc. and Cook Endoscopy and Boston Scientific, Inc. Dr. Yen and Dr. Heif have none to declare.

Author information

Authors and Affiliations

  1. University of Colorado Anschutz Medical Campus, Mail Stop F735, Rm. AIP 2.031, 1635 Aurora Ct., Aurora, CO, 80045, USA

    Muhannad Heif, Roy D. Yen & Raj J. Shah

Authors
  1. Muhannad Heif
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Roy D. Yen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Raj J. Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Raj J. Shah.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Heif, M., Yen, R.D. & Shah, R.J. ERCP with Probe-Based Confocal Laser Endomicroscopy for the Evaluation of Dominant Biliary Stenoses in Primary Sclerosing Cholangitis Patients. Dig Dis Sci 58, 2068–2074 (2013). https://doi.org/10.1007/s10620-013-2608-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-013-2608-y

Keywords

Search

Navigation