Percutaneous transhepatic cholangioscopy for diagnosis and therapy of biliary diseases in older patients

Comparative efficacy and safety of SpyGlass percutaneous transhepatic cholangioscopy versus conventional cholangioscopy in challenging biliary access: a systematic review and meta-analysis

Percutaneous transhepatic cholangioscopy (PTCS) is essential for managing patients with altered biliary anatomy when endoscopic retrograde cholangiopancreatography fails. This study aimed to compare the safety and efficacy of conventional PTCS (C-PTCS) with the SpyGlass PTCS (S-PTCS) system in cases of challenging biliary access. A systematic review and meta-analysis included 12 studies with 998 patients. Results indicated that S-PTCS had a significantly higher clinical success rate of 99% [confidence interval (CI): 96-100%] compared to 84% (CI: 73-95%) for C-PTCS ( P  < 0.01). Both techniques showed high technical success rates of 99% (CI: 96-100%) for S-PTCS and 98% (CI: 97-100%) for C-PTCS, with no significant difference ( P  = 0.61). Safety outcomes, such as pain, liver ischemia, hemobilia, cholangitis, and bleeding, were low and similar across both techniques. These findings highlight the superior clinical success of S-PTCS in challenging biliary access cases while maintaining comparable safety profiles with C-PTCS.

The usefulness of percutaneous transhepatic cholangioscopy for identifying malignancies in distal common [corrected] bile duct strictures

The diagnostic accuracy of percutaneous transhepatic cholangioscopy (PTCS) was compared to that of three radiologic modalities in distal common bile duct (CBD) strictures for the evaluation of clinical application. Ninety-five patients who underwent PTCS for the evaluation of distal CBD strictures (35 malignant and 60 benign) whose masses were not obvious from radiologic imagings were included. Confirmative diagnosis could not be reached by endoscopic retrograde cholangiopancreatography (ERCP) or radiologic findings in all cases. Specific findings on the computed tomography (CT), magnetic resonance cholangiopancreatography (MRCP) and direct cholangiography were analyzed among 68 (25 malignant and 43 benign) out of the 95 patients in order to determine the sensitivity and specificity of three radiologic studies for the diagnosis of malignant distal CBD strictures, and to compare those results with those by a combination of PTCS-guided biopsy and tumor vessel observation on cholangioscopy. The sensitivity/specificity of CT, MRCP and direct cholangiography including ERCP in diagnosing malignant distal CBD strictures were 42.9%/65.8%, 53.3%/58.3%, and 70.8%/47.6% respectively, while it was 96%/100% for the combination of PTCS-guided biopsy and tumor vessel. PTCS is a useful method for differential diagnosis of distal CBD strictures, particularly when it is difficult to distinguish benign from malignant strictures by radiologic studies and when peroral approach is not feasible.

Usefulness of cholangioscopy in patients with focal stricture of the intrahepatic duct unrelated to intrahepatic stones

BACKGROUND

Intrahepatic duct strictures are usually caused by intrahepatic duct stones and cholangitis. However, focal strictures of the intrahepatic duct unrelated to intrahepatic stones often pose diagnostic problems. This study was undertaken to prospectively evaluate the usefulness of percutaneous transhepatic cholangioscopy in patients with focal intrahepatic duct stricture and no evidence of a stone.

METHODS

Seventeen patients with focal strictures of the intrahepatic duct without any evidence of a stone were included. Percutaneous transhepatic cholangioscopic examination including procurement of biopsy specimens was performed after percutaneous transhepatic biliary drainage.

RESULTS

A histopathologic diagnosis was obtained in all patients (9 adenocarcinomas, 1 squamous cell carcinoma, 2 hepatocellular carcinomas, 2 adenomas, and 3 benign strictures). Of the 9 patients with bile duct adenocarcinoma, 8 underwent surgery and a curative resection was possible in 7 patients (88%). Five patients (63%) had early-stage bile duct cancer in which cancer invasion was limited to the mucosa or fibromuscular layer and there was no evidence of lymph node metastasis.

CONCLUSIONS

Percutaneous transhepatic cholangioscopy in patients with focal stricture of the intrahepatic duct unrelated to choledocholithiasis is useful for diagnosis including the detection of early bile duct cancer.