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Probe-Based Confocal Endomicroscopy in Primary Sclerosing Cholangitis: Not All Inflammatory Strictures Are the Same

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Abstract

Background and Study Aims

Primary sclerosing cholangitis (PSC) frequently causes inflammatory strictures (IS). The Paris Classification (PC) for probe-based confocal laser endomicroscopy (pCLE) identifies four descriptive criteria of IS. We aim to compare the pCLE findings of IS in PSC and non-PSC patients.

Patients and Methods

This is a single-center, retrospective review of all histologically proven IS evaluated with pCLE with at least 6 months of follow-up. All pCLE images were reviewed for each criteria of the PC: (1) vascular congestion, (2) dark granular pattern, (3) increased inter-glandular space, and (4) thickened reticular structures (TRS). The clinical status (PSC vs. non-PSC) was blinded to the reviewer. Univariate, multivariate, and stepwise logistic regression analyses were conducted. The primary outcome was the number of PC criteria present in PSC versus non-PSC.

Results

A total of 35 patients (13 PSC, 22 non-PSC) were included (mean age 59.1 years, 25.7 % male). Each of the PC criteria was present more frequently in non-PSC patients. The presence of TRS was significantly different (95 vs. 62 %, p = 0.01). All patients had at least two criteria present, but non-PSC patients had a significantly higher frequency of three criteria (95 vs. 38 %, p < 0.001) and four criteria (55 vs. 23 %, respectively, one-tailed p = 0.03) present.

Conclusion

In patients with IS, the individual and combined components of the PC are present in higher frequency in non-PSC patients. The presence of TRS is 13 times more likely to predict non-PSC etiologies. Refined pCLE criteria may be required to evaluate IS in patients with PSC.

Clinical trial registration number

NCT02166086.

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Abbreviations

pCLE:

Probe-based confocal laser endomicroscopy

ERCP:

Endoscopic retrograde cholangiopancreatography

PC:

Paris Classification

IS:

Inflammatory strictures

EUS:

Endoscopic ultrasound

US:

United States

EU:

Europe

PSC:

Primary sclerosing cholangitis

CCA:

Cholangiocarcinoma

FISH:

Fluorescence in situ hybridization

CT:

Computed tomography

Fr:

French

FCSEMS:

Fully covered, self-expanding metal stent

MRI:

Magnetic resonance imaging

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Declaration of Funding Source

No funding support for this study or work featured prominently in this publication.

Authorship

Kunal Karia MD: Study concept and design, acquisition of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content. Armeen Jamal-Kabani FNP-BC: Acquisition of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content. Amy Tyberg MD: Acquisition of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content. Reem Z. Sharaiha MD: Acquisition of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content. Monica Gaidhane MD, MPH: Acquisition of data, interpretation of data, critical revision of the manuscript for important intellectual content, study coordination. Michel Kahaleh MD: Study concept and design, acquisition of data, critical revision of the manuscript for important intellectual content, study supervision.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Weill Cornell Medical College, 1305 York Avenue, 4th Floor, New York, NY, 10021, USA

    Kunal Karia, Armeen Jamal-Kabani, Monica Gaidhane, Amy Tyberg, Reem Z. Sharaiha & Michel Kahaleh

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  1. Kunal Karia
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  2. Armeen Jamal-Kabani
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  3. Monica Gaidhane
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  6. Michel Kahaleh
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Corresponding author

Correspondence to Michel Kahaleh.

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Conflict of interest

Michel Kahaleh MD has received grant support from Boston Scientific, Fujinon, EMcison, Xlumena Inc., W.L. Gore, MaunaKea, Apollo Endosurgery, Cook Endoscopy, ASPIRE Bariatrics, GI Dynamics, NinePoint Medical, Merit Medical and MI Tech. He is a consultant for Boston Scientific, MaunaKea Tech, and Concordia. All other authors have no conflicts of interest to report.

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Karia, K., Jamal-Kabani, A., Gaidhane, M. et al. Probe-Based Confocal Endomicroscopy in Primary Sclerosing Cholangitis: Not All Inflammatory Strictures Are the Same. Dig Dis Sci 61, 283–286 (2016). https://doi.org/10.1007/s10620-015-3827-1

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  • DOI: https://doi.org/10.1007/s10620-015-3827-1

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