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

• Published in: Digestive diseases and sciences 2013-07, Vol.58 (7), p.2068-2074
• Main Authors: Heif, Muhannad, Yen, Roy D., Shah, Raj J.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Bile Duct Neoplasms - complications; Bile Duct Neoplasms - diagnosis; Bile Ducts, Intrahepatic - diagnostic imaging; Bile Ducts, Intrahepatic - pathology; Biochemistry; Cholangiocarcinoma - complications; Cholangiocarcinoma - diagnosis; Cholangiopancreatography, Endoscopic Retrograde - instrumentation; Cholangiopancreatography, Endoscopic Retrograde - methods; Cholangitis, Sclerosing - complications; Cholestasis, Intrahepatic - etiology; Endoscopic retrograde cholangiopancreatography; Feasibility Studies; Female; Follow-Up Studies; Gastroenterology; Hepatology; Humans; Liver; Male; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Microscopy, Confocal - instrumentation; Middle Aged; Oncology; Original Article; Pneumoviridae; Retrospective Studies; Sensitivity and Specificity; Transplant Surgery; Transplantation of organs, tissues, etc
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-013-2608-y

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.