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Efficacy of digital single-operator cholangioscopy in the visual interpretation of indeterminate biliary strictures: a systematic review and meta-analysis

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Abstract

Objective

Indeterminate biliary strictures remain a significant diagnostic challenge. Digital single-operator cholangioscopy (D-SOC) incorporates digital imaging which enables higher resolution for better visualization and diagnosis of biliary pathology. We aimed to conduct a systematic review and meta-analysis of available literature in an attempt to determine the efficacy of D-SOC in the visual interpretation of indeterminate biliary strictures.

Material and methods

Electronic searches were performed using Medline (PubMed), EMBASE, and Cochrane Library. All D-SOC studies that reported the diagnostic performance in visual interpretation of indeterminate biliary strictures and biliary malignancies were included. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 was used to evaluate the quality of the included studies. All data were extracted and pooled to construct a 2 × 2 table. The visual interpretation of D-SOC was compared to resected surgical specimens or clinical follow-up in the included patients. Pooled sensitivity, specificity, positive predictive value, negative predictive value, prevalence, positive likelihood ratio (+LR), negative likelihood ratio (−LR), and diagnostic odds ratio (OR) were calculated. The summarized receiver operating characteristic (SROC) curve corresponding with the area under the curve (AUC) was also analyzed.

Results

The search yielded 465 citations. Of these, only six studies with a total of 283 procedures met inclusion criteria and were included in the meta-analysis. The overall pooled sensitivity and specificity of D-SOC in the visual interpretation of biliary malignancies was 94% (95% CI 89–97) and 95% (95%CI 90–98), respectively, while +LR, −LR, diagnostic OR, and AUC were 15.20 (95%CI 5.21–44.33), 0.08 (95%CI 0.04–0.14), 308.83 (95%CI 106.46–872.82), and 0.983, respectively. The heterogeneity among 6 included studies was moderate for specificity (I2 = 0.51) and low for sensitivity (I2 = 0.17) and diagnostic OR (I2 = 0.00).

Conclusion

D-SOC is associated with high sensitivity and specificity in the visual interpretation of indeterminate biliary strictures and malignancies. D-SOC should be considered routinely in the diagnostic workup of indeterminate biliary lesions.

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Authors and Affiliations

  1. Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo – HC/FMUSP, Av. Dr. Enéas de Carvalho Aguiar, 255, Instituto Central - Prédio dos Ambulatórios, Cerqueira César, São Paulo, SP, CEP: 05403-000, Brazil

    Pedro Victor Aniz Gomes de Oliveira, Diogo Turiani Hourneaux de Moura, Igor Braga Ribeiro, Tomazo Antonio Prince Franzini, Marcos Eduardo Lera dos Santos, Wanderley Marques Bernardo & Eduardo Guimarães Hourneaux de Moura

  2. Department of Medicine, West Virginia University Health Sciences Center Charleston Division, Charleston, WV, USA

    Ahmad Najdat Bazarbashi

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  1. Pedro Victor Aniz Gomes de Oliveira
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Contributions

PVAGO: acquisition of data, analysis, interpretation of data, drafting the article, revising the article, final approval; DTHDM: acquisition of data, analysis, interpretation of data, drafting the article, revising the article, final approval; IBR: analysis and interpretation of data, revising the article; ANDB: analysis and interpretation of data, revising the article; TPF: analysis and interpretation of data, drafting the article, final approval; MELDS: analysis and interpretation of data, drafting the article, final approval; WMB: analysis and interpretation of data, drafting the article, final approval; EGHDM analysis and interpretation of data, drafting the article, revising the article, final approval;

Corresponding author

Correspondence to Igor Braga Ribeiro.

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Disclosures

Drs. Tomazo Antonio Prince Franzin and Marcos Eduardo Lera dos Santos reports personal fees from BOSTON SCIENTIFIC, outside the submitted work; Dr. Eduardo Guimarães Hourneaux de Moura reports personal fees from Boston Scientific, personal fees from Olympus, outside the submitted work. Drs. Pedro Victor Aniz Gomes de Oliveira, Diogo Turiani Hourneaux de Moura, Igor Braga Ribeiro, Ahmad Najdat Bazarbashi, and Wanderley Marques Bernardo have nothing to disclose.

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The study was approved by the Research Ethics Committee of the University of São Paulo School of Medicine Hospital das Clínicas and written consent was not required as this was a systematic review project.

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de Oliveira, P.V.A.G., de Moura, D.T.H., Ribeiro, I.B. et al. Efficacy of digital single-operator cholangioscopy in the visual interpretation of indeterminate biliary strictures: a systematic review and meta-analysis. Surg Endosc 34, 3321–3329 (2020). https://doi.org/10.1007/s00464-020-07583-8

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