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• W3201110873 abstract "<h3>Introduction</h3> PSC carries a 15–20% lifetime risk of developing cholangiocarcinoma (CCA). The distinction between benign and malignant strictures in this patient cohort is uniquely challenging. A 2016 meta-analysis has shown that single operator cholangioscopy (SOC) with targeted biopsies appears to be the most accurate method.¹ We report our experience of SOC and PSC stricture assessment. <h3>Methods</h3> In 2 tertiary UK referral centres all patients who had a Spyglass DS™ SOC for stricture assessment in PSC were retrospectively enrolled. From clinical records and the endoscopy reporting tool patient demographics, degree of suspicion on referral, degree of suspicion during the endoscopy, histological diagnosis, and eventual diagnosis were assessed. Pre-test suspicion of malignancy was judged as high (eg. new stricture; presentation with obstructive jaundice; rising CA19.9; lesion on imaging) or low (eg. pre-transplant stricture assessment). <h3>Results</h3> Data on 49 patients who had undergone 52 ERCPs and Spyglass DS™ SOC was analysed. Four cases of malignancy were confirmed; 3 had a high level of suspicion at SOC and 1 had a low level of suspicion Nine cases (17.3%) had prior suspicious brushings locally which warranted further investigation. Three of these had CCA confirmed and 6 had no evidence of malignancy on SOC. Three of those with histological confirmed malignancy had cytology highly suggestive of high-grade dysplasia or adenocarcinoma from previous ERCPs. Another patient had negative histology at SOC but was referred for surgery on the basis of a mass lesion on imaging. One patient developed CCA within 1 year of negative SOC and another was found to have CCA on transplant explant at site of stricture assessed 6 years earlier with SOC. A negative SOC enabled 12 patients to be referred for transplantation. <h3>Conclusion</h3> The role of SOC in stricture assessment in PSC remains unclear. In this series SOC picked up 1 case of CCA not detected on standard ERCP as well as not detecting at least 1 case of CCA. Despite improved image quality using Spyglass DS™ SOC visual diagnosis remains challenging. It is hoped that advances in tissue acquisition will improve the yield from targeted biopsies. However, SOC appears to have an important role in assessing strictures where brush cytology is indeterminate. <h3>Reference</h3> Njei B, <i>et al</i>. Systematic review with meta-analysis: endoscopic retrograde cholangiopancreatography-based modalities for the diagnosis of cholangiocarcinoma in primary sclerosing cholangitis. <i>Aliment Pharmacol Ther</i> 2016;<b>44</b>(11–12):1139–51." @default.
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• W3201110873 date "2021-01-01" @default.
• W3201110873 modified "2023-09-23" @default.
• W3201110873 title "P48 The use of cholangioscopy for stricture assessment in primary sclerosing cholangitis (PSC)" @default.
• W3201110873 doi "https://doi.org/10.1136/gutjnl-2020-bsgcampus.123" @default.
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