Is there a role for cholangioscopy in patients with PSC?

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Am J Gastroenterol.

2006 Feb.

Is

there a role for cholangioscopy in patients with

primary sclerosing cholangitis?

Awadallah

NS, Chen

YK, Piraka

C, Antillon

MR, Shah

RJ.

Division of Gastroenterology, Depart Internal Medicine, University

of Colorado Health Sciences Center,

Denver, Colorado.

OBJECTIVES: Assess the role of cholangioscopy in

primary sclerosing cholangitis

for 1) detection of cholangiocarcinoma using cholangioscopy-assisted biopsy 2) detection of stones not seen

on cholangiography 3) stone removal with cholangioscopy-directed lithotripsy. METHODS: Prospective

cohort of consecutive patients referred for cholangioscopy

to evaluate dominant strictures or stones. A data collection sheet was

employed. Follow-up was by chart review/phone contact. Clinical improvement was

defined as resolution of jaundice or >/=50% reduction in pain or cholangitis episodes requiring hospitalization. RESULTS: 41

patients (30M, 11F) had 60 cholangioscopy procedures

(55 per oral, 5 percutaneous). 33/41 (80%) patients

underwent 44 tissue sampling events. Histology: positive for extrahepatic cholangiocarcinoma (N = 1), negative/atypical (N = 31), and

inadequate (N = 1). Stones were found in 23/41 (56%) patients, of which 7/23

(30%) were missed on cholangiography and detected

only by cholangioscopy. 9/23 (39%) underwent cholangioscopy-directed lithotripsy. Stone clearance:

complete (N = 10, 7 by cholangioscopy-directed

lithotripsy after failed conventional stone extraction); partial (N = 7); and

not attempted (N = 6). Median follow-up was 17.0 months (range 1-56). Clinical

improvement was achieved in 25/40 (63%). Eight patients have undergone

transplant and cholangiocarcinoma was present in the explant of two at 1 and 12 months post-cholangioscopy,

respectively. CONCLUSIONS: This is the

first series of patients with primary sclerosing cholangitis undergoing cholangioscopy

for the evaluation of dominant strictures and cholangioscopy-directed

stone therapy with demonstrable clinical benefits. Stones detected by cholangioscopy were missed by cholangiography

in nearly one of three patients. Cholangioscopy-directed

lithotripsy may be superior to conventional ERCP for achieving complete stone

clearance. Despite the use of cholangioscopy,

diagnosis of cholangiocarcinoma remains technically

challenging.

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