Is single-operator peroral cholangioscopy a useful tool for the diagnosis of indeterminate XXXX ? A systematic review and meta-analysis.

@entity1 @entity253 @entity5
BACKGROUND: Differentiating between malignant and benign biliary lesions is critical in clinical practice but is difficult. OBJECTIVE: To systematically evaluate the diagnostic performance of single-operator peroral cholangioscopy on indeterminate biliary lesions. DESIGN: A systematic review and meta-analysis. @entity1 : @entity1 with indeterminate biliary lesions or equivocal ERCP findings. MAIN OUTCOME MEASUREMENTS: The diagnostic performance of single-operator peroral cholangioscopy on  indeterminate biliary lesions. The area under the summary receiver-operating characteristic curve was used as the main indicator for the overall diagnostic performance of single-operator peroral cholangioscopy visual  impression (VI) and SpyBite biopsy (SB). The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were also synthesized. RESULTS: A total of 8 studies met the inclusion criteria, involving 335 @entity1 who had data on VI and 337 who had  data on SB. The area under the curve values on the summary receiver-operating characteristic curve of single-operator peroral cholangioscopy VI and SB were 0.94 (95% confidence interval [CI], 0.92-0.96) and 0.93 (95% CI,  0.90-0.95) respectively. The combined sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were 90% (95% CI, 73%-97%), 87% (95% CI, 76%-94%), 7.1 (95% CI, 3.8-13.3), 0.12 (95% CI, 0.04-0.33) for VI  and 69% (95% CI, 57%-79%), 98% (95% CI, 92%-99%), 30.1 (95% CI, 8.5-106.9), and 0.32 (95% CI, 0.23-0.44) for  SB, respectively. LIMITATIONS: Small number of included studies; comparison with ERCP could not be made. CONCLUSION: Single-operator peroral cholangioscopy is a good tool for differentiating @entity253 . VI is useful for detecting malignant lesion, whereas SB is better at confirming a malignant diagnosis, but VI is not perfect in excluding @entity5 , nor is SB, and their negative results should be interpreted with caution.
