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• W2773438816 abstract "The diagnosis of indeterminate bile duct strictures is challenging because of the low sensitivity and accuracy of tissue biopsy sampling or brush cytology with the use of ERCP.1Ponchon T. Gagnon P. Berger F. et al.Value of endobiliary brush cytology and biopsies for the diagnosis of malignant bile duct stenosis: results of a prospective study.Gastrointest Endosc. 1995; 42: 565-572Abstract Full Text Full Text PDF PubMed Scopus (322) Google Scholar Probe-based confocal laser endomicroscopy (pCLE) is a safe, innovative endoscopic method, which offers the potential of real-time in vivo diagnosis. High sensitivity, negative predictive value, and diagnostic accuracy (>95%) have been demonstrated by the use of pCLE according to the Miami and Paris classifications for biliary strictures.2Wallace M. Lauwers G.Y. Chen Y. et al.Miami classification for probe-based confocal laser endomicroscopy.Endoscopy. 2011; 43: 882-891Crossref PubMed Scopus (194) Google Scholar, 3Caillol F. Filoche B. Gaidhane M. et al.Refined probe-based confocal laser endomicroscopy classification for biliary strictures: the Paris Classification.Dig Dis Sci. 2013; 58: 1784-1789Crossref PubMed Scopus (89) Google Scholar, 4Slivka A. Gan I. Jamidar P. et al.Validation of the diagnostic accuracy of probe-based confocal laser endomicroscopy for the characterization of indeterminate biliary strictures: results of a prospective multicenter international study.Gastrointest Endosc. 2015; 81: 282-290Abstract Full Text Full Text PDF PubMed Scopus (96) Google Scholar A 62-year-old woman presented with abdominal pain, vomiting, and jaundice. After the diagnosis of cholecystitis and cholelithiasis, she underwent cholecystectomy and ERCP in another hospital. After 3 months, she presented with recurrent jaundice and weight loss of 23 kg (about 30% of body weight) without signs of cholangitis. An abdominal CT scan identified a solid mass at the hilum (Fig. 1). Owing to infiltration of the hepatic artery, surgical resection was contraindicated. The patient underwent ERCP for biliary drainage in addition to pCLE evaluation of the hilar stricture with the use of CholangioFlex (Mauna Kea Technologies, Paris, France). The resulting images showed characteristics of malignant stenosis with thick bands, and increased dark cells (Fig. 2). Biopsy specimens were obtained, and brush cytology was performed to confirm the diagnosis, followed by the insertion of plastic stents. After histologic confirmation of cholangiocarcinoma, the patient underwent another ERCP for radiofrequency ablation (bipolar catheter Habib EndoHPB, Montreal, Canada [7 watts for 90 seconds]) and bilateral biliary drainage with a self-expanding metal stent (SEMS) (Fig. 3; Video 1, available online at www.VideoGIE.org). The patient was discharged from the hospital 48 hours later, with gradual decreasing of bilirubin levels, and she survived for another 9 months. The pCLE procedure may provide in vivo real-time diagnosis. In a scenario in which the multidisciplinary oncologic team recognizes pCLE findings valuable for decision making, pCLE would allow immediate management and advanced treatment in a single session. The application of radiofrequency ablation is safe and may prolong survival.5Steel A.W. Postgate A.J. Khorsandi S. et al.Endoscopically applied radiofrequency ablation appears to be safe in the treatment of malignant biliary obstruction.Gastrointest Endosc. 2011; 73: 149-153Abstract Full Text Full Text PDF PubMed Scopus (245) Google Scholar The effectiveness of such a strategy should be assessed in large prospective studies. All authors disclosed no financial relationships relevant to this publication. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiJjYzBmYzI4MjlhNjljZDFlNWI2MGNkODAyMjQ4MmRhYiIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjc4NjQwMTEwfQ.gB-sc9Qcvv8YrKP3ef5HjVVAQxmNMZBwPhRyBB0mxngznZotYqkIpsrTvTNKiY-o9G2pIfO4ZsnLOVjwcwJ-RFmgvFrcXtsdYLuh41rdQQHptbuiqkRqjFXPflJiDK4uh5IXT0oU2AwVKaJg6OzIUwz_s48Iz6lDTfwI3BuBLW5udGEwS3bzh4OfyKEhNmk1-CmpKq_zCp3GJmTzK5rRCQQqPG9ot1i0PaCU0K6BlWNboITd3iikt5h7Lwy3bKmhVX6JFN1SqXZttde6zlWK6CRYqFlIsr8T8ic913KIUKCrrhhqM1m1VAqSPzAO7x7f1I_E8HZ_WWak8G0qagx0hA Download .mp4 (33.91 MB) Help with .mp4 files Video 1Probe-based confocal endomicroscopy for the management of indeterminate bile duct strictures. Download .pdf (.02 MB) Help with pdf files Video Script" @default.
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• W2773438816 date "2018-01-01" @default.
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• W2773438816 title "The impact of probe-based confocal endomicroscopy on the management of indeterminate bile duct strictures" @default.
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