Surgical Endoscopy

, Volume 25, Issue 7, pp 2247–2253 | Cite as

Results of a phase I–II study on intraductal confocal microscopy (IDCM) in patients with common bile duct (CBD) stenosis

  • M. Giovannini
  • E. Bories
  • G. Monges
  • C. Pesenti
  • F. Caillol
  • J. R. Delpero



Confocal endomicroscopy is an emergent technique and allows real optical biopsies in the gastrointestinal (GI) tract. The aim of this study was to evaluate a new intraductal confocal miniprobe in patients with a normal common bile duct (CBD) or with a suspicion of a malignant stenosis (cholangiocarcinoma).


Thirty-seven patients (23 males) underwent endoscopic retrograde cholangiopancreatography (ERCP) for bile duct stone removal (7 cases) or bile duct stenosis (30 cases). Intraductal confocal microscopy (IDCM) was performed during the ERCP using a probe-based confocal laser endomicroscopy (pCLE) technique. IDCM was done with the CholangioFlex probe with Cellvizio (Mauna Kea Technologies, Paris, France). The depth of penetration of theCholangioFlex probe was 40–70 μm and magnification was 400×. Images were reviewed by an experienced pathologist in GI disease and compared to ERCP findings, CBD biopsies performed during ERCP or EUS, and in 15 patients to the resected specimen (Wipple resection).


No complications related to the CholangioFlex insertion occurred after the ERCP. Good images were obtained in 33 patients. Final histology diagnosis was a normal CBD in 7 cases, 23 malignant stenoses (4 ampullary carcinomas, 13 cholangiocarcinomas, and 6 pancreatic cancer), and 7 inflammatory stenoses (4 chronic pancreatitis, 1 stenosis of hepaticojejunal anastomosis, 1 postcholecystectomy CBD stenosis, and 1 primary sclerosing cholangitis). IDCM of a normal CBD showed a thin black band (<20 μm), normal vessels (thin and regular), and no visible glands. IDCM of malignant strictures revealed irregular vessels with lack of contrast in the CBD wall, large black band (>20 μm), and an aggregate of irregular black cells (black clumps). These aspects were seen in all malignant stenoses and none were seen in benign or normal CBD. The presence of irregular vessels, large black bands, and black clumps seen with confocal laser microscopy enabled prediction of neoplasia with an accuracy rate of 86%, sensitivity of 83%, and specificity of 75%. The respective numbers for standard histopathology were 53, 65, and 53%.


This phase I–II study on IDCM showed that IDCM is feasible. This new technique will open a new door for optical biopsy of the CBD.


Pancreato Bilio Endoscopy CBD (common bile duct) Tissue Imaging & VR 



M. Giovannini, E. Bories, G. Monges, C. Pesenti, F. Caillol, and J.-R. Delpero have no conflicts of interest or financial ties to disclose.


  1. 1.
    Anderson CD, Pinson CW, Berlin J, Chari RS (2004) Diagnosis and treatment of cholangiocarcinoma. Oncologist 9:43–57PubMedCrossRefGoogle Scholar
  2. 2.
    Fevery J, Verslype C, Lai G, Aerts R, Van Steenbergen W (2007) Incidence, diagnosis, and therapy of cholangiocarcinoma in patients with primary sclerosing cholangitis. Dig Dis Sci 52:3123–3135PubMedCrossRefGoogle Scholar
  3. 3.
    Lee WJ, Lim HK, Jang KM, Kim SH, Lee SJ, Lim JH, Choo IW (2001) Radiologic spectrum of cholangiocarcinoma: emphasis on unusual manifestations and differential diagnoses. Radiographics 21:S97–S116PubMedGoogle Scholar
  4. 4.
    Khan SA, Davidson BR, Goldin R, Pereira SP, RosenbergWM, Taylor-Robinson SD, Thillainayagam AV, Thomas HC, Thursz MR, Wasan H; British Society of Gastroenterology (2002) Guidelines for the diagnosis and treatment of cholangiocarcinoma: consensus document. Gut 51 Suppl 6:VI1–9Google Scholar
  5. 5.
    Khan SA, Thomas HC, Davidson BR, Taylor-Robinson SD (2005) Cholangiocarcinoma. Lancet 366(9493):1303–1314PubMedCrossRefGoogle Scholar
  6. 6.
    Burak K, Angulo P, Pasha TM, Egan K, Petz J, Lindor KD (2004) Incidence and risk factors for cholangiocarcinoma in primary sclerosing cholangitis. Am J Gastroenterol 99:523–526PubMedCrossRefGoogle Scholar
  7. 7.
    Boberg KM, Bergquist A, Mitchell S, Pares A, Rosina F, Broome U, Chapman R, Fausa O, Egeland T, Rocca G, Schrumpf E (2002) Cholangiocarcinoma in primary sclerosing cholangitis: risk factors and clinical presentation. Scand J Gastroenterol 37:1205–1211PubMedCrossRefGoogle Scholar
  8. 8.
    Malhi H, Gores GJ (2006) Cholangiocarcinoma: modern advances in understanding a deadly old disease. J Hepatol 45:856–867PubMedCrossRefGoogle Scholar
  9. 9.
    Rosch T, Meining A, Fruhmorgen S, Zillinger C, Schusdziarra V, Hellerhoff K, Classen M, Helmberger H (2002) A prospective comparison of the diagnostic accuracy of ERCP, MRCP, CT, and EUS in biliary strictures. Gastrointest Endosc 55:870–876PubMedCrossRefGoogle Scholar
  10. 10.
    Materne R, Van Beers BE, Gigot JF, Jamart J, Geubel A, Pringot J, Deprez P (2000) Extrahepatic biliary obstruction: magnetic resonance imaging compared with endoscopic ultrasonography. Endoscopy 32:3–9PubMedCrossRefGoogle Scholar
  11. 11.
    Romagnuolo J, Bardou M, Rahme E, Joseph L, Reinhold C, Barkun AN (2003) Magnetic resonance cholangiopancreatography: a meta-analysis of test performance in suspected biliary disease. Ann Intern Med 139:547–557PubMedGoogle Scholar
  12. 12.
    Domagk D, Wessling J, Reimer P, Hertel LPC, Senninger N, Heinicke A, Domschke W, Menzel J (2004) Endoscopic retrograde cholangiopancreatography, intraductal ultrasonography, and magnetic resonance cholangiopancreatography in bile duct strictures: a prospective comparison of imaging diagnostics with histopathological correlation. Am J Gastroenterol 99:1684–1689PubMedCrossRefGoogle Scholar
  13. 13.
    Domagk D, Poremba C, Dietl KH, Senninger N, Heinicke A, Domschke W, Menzel J (2002) Endoscopic transpapillary biopsies and intraductal ultrasonography in the diagnostics of bile duct strictures: a prospective study. Gut 51:240–244PubMedCrossRefGoogle Scholar
  14. 14.
    Meining A, Saur D, Bajbouj M, Becker V, Peltier E, Höfler H, von Weyhern CH, Schmid RM, Prinz C (2007) In-vivo histopathology for detection of gastrointestinal neoplasia using a portable, confocal miniprobe: an examiner blinded analysis. Clin Gastroenterol Hepatol 5:1261–1267PubMedCrossRefGoogle Scholar
  15. 15.
    George M, Meining A (2003) Cresyl violet as a fluorophore for future in vivo histopathology. Endoscopy 35:585–590PubMedCrossRefGoogle Scholar
  16. 16.
    Kiesslich R, Goetz M, Burg J, Stolte M, Siegel E, Maeurer MJ, Thomas S, Strand D, Galle PR, Neurath MF (2005) Diagnosing Helicobacter pylori in vivo by confocal laser endoscopy. Gastroenterology 128:2119–2123PubMedCrossRefGoogle Scholar
  17. 17.
    Polglase AL, McLaren WJ, Skinner SA, Kiesslich R, Neurath MF, Delaney PM (2005) A fluorescence confocal endomicroscope for in vivo microscopy of the upper- and the lower-GI tract. Gastrointest Endosc 62:686–695PubMedCrossRefGoogle Scholar
  18. 18.
    Becker V, Vercauteren T, von Weyhern CH, Prinz C, Schmid RM, Meining A (2007) High resolution miniprobe-based confocal microscopy in combination with video mosaicing. Gastrointest Endosc 66:1001–1007PubMedCrossRefGoogle Scholar
  19. 19.
    Thiberville L, Moreno-Swirc S, Vercauteren T, Peltier E, Cavé C, Bourg Heckly G (2007) In vivo imaging of the bronchial wall microstructure using fibered confocal fluorescence microscopy. Am J Respir Crit Care Med 175:22–31PubMedCrossRefGoogle Scholar
  20. 20.
    D’Hallewin MA, El Khatib S, Leroux A, Bezdetnaya L, Guillemin F (2005) Endoscopic confocal fluorescence microscopy of normal and tumor bearing rat bladder. J Urol 174:736–740PubMedCrossRefGoogle Scholar
  21. 21.
    Meining A, Frimbirger E, Becker V, Vopn Delius S, Von Weyhern CH, Schmid RM, Prinz C (2008) Detection of cholangiocarcinoma in vivo using miniprobe-based confocal fluorescence microscopy. Clin Gastroenterol Hepatol 6:1057–1060PubMedCrossRefGoogle Scholar
  22. 22.
    Taniguchi K, Iida T, Hori T, Yagi S, Imai H, Shiraishi T, Uemoto S (2006) Impact of lymph node micrometastasis in hilar bile duct carcinoma patients. World J Gastroenterol 12:2549–2555PubMedGoogle Scholar
  23. 23.
    Park BK, Paik YH, Park JY, Park KH, Bang S, Park SW, Chung JB, Park YN, Song SY (2006) The clinicopathologic significance of the expression of vascular endothelial growth factor-C in intrahepatic cholangiocarcinoma. Am J Clin Oncol 29:138–142PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • M. Giovannini
    • 1
  • E. Bories
    • 1
  • G. Monges
    • 2
  • C. Pesenti
    • 1
  • F. Caillol
    • 1
  • J. R. Delpero
    • 3
  1. 1.Endoscopic UnitPaoli-Calmettes InstituteMarseilles cedex 9France
  2. 2.Biopathology UnitPaoli-Calmettes InstituteMarseilles cedex 9France
  3. 3.Surgery UnitPaoli-Calmettes InstituteMarseilles cedex 9France

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