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Digital single-operator peroral cholangioscopy-guided biopsy sampling versus ERCP-guided brushing fo

Digital single-operator peroral cholangioscopy-guided biopsy sampling versus ERCP-guided brushing for indeterminate biliary strictures: a prospective, randomized, multicenter trial.


Christian Gerges, MD1,∗Torsten Beyna, MD1,∗ Raymond S.Y. Tang, MD2 Farzan Bahin, FRACP, PhD1 James Y.W. Lau, MD, PhD2 Erwin van Geenen, MD, PhD3 Horst Neuhaus, MD1 Duvvur Nageshwar Reddy, MD4,5 Mohan Ramchandani, MD5,∗

Gastrointest Endosc 2020;91:1105-13

The definitive diagnosis of an indeterminate biliary stenosis is a real challenge in the daily endoscopic practice, with the arrival of digital cholangioscopy the diagnostic profitability has increased considerably according to different studies.

Christian Gerges et al, conducted a multicenter, randomized, prospective study, including 60 patients with indeterminate biliary stenosis (by MR cholangiography) by randomizing them: one group to ERCP with stenosis brushing and another group to cholangioscopy with biopsies.

The sensitivity obtained was 68.% vs 21.4% in favor of biopsy by cholangioscopy, (p< 0.01), however, the parameters of specificity, negative and positive predictive value showed no significant difference.

The visual impression in the cholangioscopy group showed a sensitivity of 95.5% vs 66.7% (p 0.02) with an overall diagnostic certainty of 87.1% vs 65.5% (p0.05) in the determination of malignancy. No difference in adverse effects.

In conclusion, cholangioscopy increases the diagnostic cost-effectiveness of undetermined biliary stenoses, and the visual impression has a significant impact on the management of these stenoses.


"Biliary cytology has a very low diagnostic yield in indeterminate biliary stenosis (no more than 40% in the best case scenario). Targeted biopsies increase diagnostic yield, and visual impression plays a key role in the characterization of biliary stenosis due to the presence of variegated neovascularization, with dilated vessels, in spiders, which can differentiate malignancy and modify the therapeutic approach as shown in this study.

I believe that digital cholangioscopy should be implemented in all ERCP units as part of the diagnostic arsenal, even more so, in the context of undetermined biliary stenosis", Dr. Juan Manuel Alcívar, IECED specialist.

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