Peroral Cholangioscopy-Guided Forceps Biopsy and Endoscopic Scraper for the Diagnosis of Indeterminate Extrahepatic Biliary Stricture.

BACKGROUND

Peroral cholangioscopy (POCS) has become a widely-used technique in diagnosing indeterminate biliary strictures, enabling optical viewing of the biliary system and targeted biopsies under direct vision. The diagnostic utility of the new endoscopic scraper, Trefle, for extrahepatic cholangiocarcinoma (ECC) has also been reported. However, the diagnostic utility of POCS-guided and Trefle-assisted tissue acquisition for ECC has never been compared empirically. We evaluated the efficacy and safety of Trefle-assisted tissue acquisition for diagnosing ECC compared with POCS-guided tissue sampling.

METHODS

Patients who underwent Trefle-assisted tissue acquisition or POCS-guided forceps biopsy to differentiate ECC from benign biliary disease between April 2014 and March 2018 were enrolled retrospectively. We evaluated the diagnostic performance of Trefle-assisted tissue acquisition and POCS-guided forceps biopsy based on pathological evaluation. We also compared adverse events associated with Trefle-assisted tissue acquisition with those of POCS-guided forceps biopsy.

RESULTS

We enrolled 34 patients with biliary disease and performed Trefle-assisted tissue acquisition and POCS-guided forceps biopsy in 14 and 20 patients, respectively. Sensitivity, specificity, and accuracy of Trefle-assisted tissue acquisition were 87.5%, 83.3%, and 85.7%, respectively, and for POCS-guided forceps biopsy, these were 90.0% each. Statistical values of Trefle-assisted tissue acquisition and POCS-guided tissue acquisition were not significantly different. There were no significant differences in the occurrence of adverse events between the Trefle-assisted tissue acquisition and the POCS-guided forceps biopsy (35.7% vs. 25.0%, 0.770). Compared with patients who underwent POCS procedure, endoscopic sphincterotomy was performed for fewer patients who underwent Trefle-assisted tissue acquisition ( 0.001).

CONCLUSIONS

The diagnostic ability of Trefle-assisted tissue acquisition for ECC is similar to that of POCS-guided tissue acquisition. Trefle-assisted tissue acquisition might also help to preserve the sphincter of Oddi and its digestive function.