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CC BY-NC-ND 4.0 · Endosc Int Open 2024; 12(02): E237-E244
DOI: 10.1055/a-2236-7557
Original article

Per-oral cholangioscopy in patients with primary sclerosing cholangitis: a 12-month follow-up study

Rachid Mohamed
1   Gastroenterology and Hepatology, University of Calgary, Calgary, Canada (Ringgold ID: RIN103136)
,
Sooraj Tejaswi
2   Division of Gastroenterology & Hepatology, University of California Davis School of Medicine, Sacramento, United States (Ringgold ID: RIN12218)
,
Lars Aabakken
3   Dept of Transplantation Medicine, Oslo University Hospital, University of Oslo, Oslo, Norway (Ringgold ID: RIN6305)
,
Cyriel Y Ponsioen
4   Gastroenterology and Hepatology, Amsterdam University Medical Centres, Amsterdam, Netherlands (Ringgold ID: RIN522567)
,
Christopher L Bowlus
2   Division of Gastroenterology & Hepatology, University of California Davis School of Medicine, Sacramento, United States (Ringgold ID: RIN12218)
,
Douglas G Adler
5   Center for Advanced Therapeutic Endoscopy, Adventist Porter Hospital, Denver,
,
Nauzer Forbes
6   Gastroenterology and Hepatology, University of Calgary, Calgary, Canada (Ringgold ID: RIN70401)
,
Vemund Paulsen
3   Dept of Transplantation Medicine, Oslo University Hospital, University of Oslo, Oslo, Norway (Ringgold ID: RIN6305)
,
Rogier P. Voermans 
4   Gastroenterology and Hepatology, Amsterdam University Medical Centres, Amsterdam, Netherlands (Ringgold ID: RIN522567)
,
Shiro Urayama
2   Division of Gastroenterology & Hepatology, University of California Davis School of Medicine, Sacramento, United States (Ringgold ID: RIN12218)
,
Joyce Peetermans
7   Clinical Endoscopy, Boston Scientific Corporation, Marlborough, United States
,
Matthew J Rousseau
7   Clinical Endoscopy, Boston Scientific Corporation, Marlborough, United States
,
Bertus Eksteen
8   Gastroenterology, Aspen Woods Clinic, Calgary, Canada
› Author AffiliationsSupported by: Boston Scientific Corporation

Clinical Trial: Registration number (trial ID): NCT03766035, Trial registry: ClinicalTrials.gov (http://www.clinicaltrials.gov/), Type of Study: Prospective, multicenter cohort study
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Abstract

Background and study aims Patients with primary sclerosing cholangitis (PSC) have a 9% to 20% lifetime incidence of cholangiocarcinoma (CCA). Per-oral cholangioscopy (POCS) added to endoscopic retrograde cholangiography (ERC) could potentially improve detection of CCA occurrence. We prospectively assessed POCS identification of 12-month CCA incidence in PSC patients undergoing ERC.

Patients and methods Consecutive patients with PSC, an indication for ERC, and no prior liver transplantation were enrolled. During the index procedure, POCS preceded planned therapeutic maneuvers. The primary endpoint was ability for POCS visualization with POCS-guided biopsy to identify CCA during 12-month follow-up. Secondary endpoints included ability of ERC/cytology to identify CCA, repeat ERC, liver transplantation, and serious adverse events (SAEs).

Results Of 42 patients enrolled, 36 with successful cholangioscope advancement were analyzed. Patients had a mean age 43.5±15.6 years and 61% were male. Three patients diagnosed with CCA had POCS visualization impressions of benign/suspicious/suspicious, and respective POCS-guided biopsy findings of suspicious/positive/suspicious for malignancy at the index procedure. The three CCA cases had ERC visualization impressions of benign/benign/suspicious, and respective cytology findings of atypical/atypical/suspicious for malignancy. No additional patients were diagnosed with CCA during median 11.5-month follow-up. Twenty-three repeat ERCs (5 including POCS) were performed in 14 patients. Five patients had liver transplantation, one after CCA diagnosis and four after benign cytology at the index procedure. Three patients (7.1%) had post-ERC pancreatitis. No SAEs were POCS-related.

Conclusions In PSC patients, POCS visualization/biopsy and ERC/cytology each identified three cases of CCA. Some patients had a repeat procedure and none experienced POCS-related SAEs.

Keywords

Cholangioscopy - Pancreatobiliary (ERCP/PTCD) - Diagnostic ERC - Endoscopy Upper GI Tract - Malignant strictures

Supplementary Material



Publication History

Received: 06 September 2023

Accepted after revision: 22 December 2023

Accepted Manuscript online:
02 January 2024

Article published online:
15 February 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

Comment to this article:

Endoscopy International Open – recently publishedEndoscopy 2024; 56(05): 394-394
DOI: 10.1055/a-2252-3068

 

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