Peroral cholangioscopy with cholangioscopy-directed biopsies in the diagnosis of biliary malignancies: a systemic review and meta-analysis. Issue 8 (August 2019)

• Record Type: Journal Article
• Authors: Badshah, Maaz B.; Vanar, Vishwas; Kandula, Manasa; Kalva, Nikhil; Badshah, Mashood B.; Revenur, Vakya; Bechtold, Matthew L.; Forcione, David G.; Donthireddy, Kavitha; Puli, Srinivas R.
• Is Part Of: European journal of gastroenterology & hepatology. Volume 31:Issue 8(2019)
• Publication Date: 2019-08
• Subjects: bile duct cancer -- bile duct stricture -- cholangioscopy -- meta-analysis -- systematic review; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; Digestive organs -- Diseases; Liver -- Diseases; Periodicals; 616.33
• DOI: 10.1097/MEG.0000000000001402
• Languages: English
• ISSNs: 0954-691X

Abstract

Abstract : Background and aim: Accurate diagnosis is essential in the appropriate management of biliary strictures. Our aim is to evaluate the efficacy of cholangioscopy-directed biopsies in differentiating biliary intraductal malignancies from benign lesions. Materials and methods: Articles were searched in Medline, PubMed, and Ovid journals. Pooling was performed by both fixed-effects and random-effects models. Only studies from which a 2×2 table could be constructed for true-positive, false-negative, false-positive, and true-negative values were included. Results: Initial search identified 2110 reference articles for peroral cholangioscopy; of these, 160 relevant articles were selected and reviewed. Data were extracted from 15 studies ( N =539) that fulfilled the inclusion criteria. Pooled sensitivity of cholangioscopy-directed biopsies in diagnosing malignancy was 71.9% [95% confidence interval (CI): 66.1–77.1] and pooled specificity was 99.1% (95% CI: 96.9–99.9). The positive likelihood ratio of cholangioscopy-directed biopsies was 18.1 (95% CI: 9.1–35.8), whereas the negative likelihood ratio was 0.3 (95% CI: 0.2–0.4). The pooled diagnostic odds ratio was 71.6 (95% CI: 32.8–156.4). All the pooled estimates calculated by fixed-effects and random-effect models were similar. Summary receiver operating characteristic curves showed an area under the curve of 0.98. The χ 2 heterogeneity for all the pooled accuracy estimates was 5.62 ( P =0.96). Conclusion: Peroral cholangioscopy with cholangioscopy-directed biopsies has a high specificity in differentiating intraductal malignancies from benign lesions. Cholangioscopy-directed biopsies should be strongly considered for biliary stricture evaluation.