Single-operator cholangioscopy and targeted biopsies in the diagnosis of indeterminate XXXX : a systematic review.

@entity5 @entity1 @entity253 @entity201
BACKGROUND AND AIMS: Evaluation of indeterminate @entity253 by brush cytology and intraductal biopsies is limited by low sensitivity. The utility of SpyGlass peroral cholangioscopy for diagnosis of @entity5 ( @entity201 ), in particular, remains unclear. Our aim was to study the utility of SpyGlass peroral cholangioscopy and targeted biopsy for diagnosis of @entity5 and @entity201 . METHODS: In this systematic review, PubMed and Embase databases were reviewed for studies published to October 2014. The main outcomes of interest were sensitivity, specificity, and diagnostic odds ratio (DOR) of SpyGlass cholangioscopy in the diagnosis of @entity5 . RESULTS: The search yielded 10 studies involving 456 @entity1 . The pooled sensitivity and specificity of cholangioscopy-guided biopsies in the diagnosis of @entity5 was 60.1% (95% confidence interval [CI], 54.9%-65.2%) and 98.0% (95% CI, 96.0%-99.0%), respectively. The pooled DOR to detect @entity5 was 66.4 (95% CI, 32.1-137.5). Four studies included @entity1 who had previous negative imaging and brushings and/or intraductal biopsies. Among these 4 studies, the pooled sensitivity and specificity for diagnosis of @entity5 was 74.7% (95% CI, 63.3%-84.0%) and 93.3% (95% CI, 85.1%-97.8%), respectively. The pooled DOR was 46.0 (95% CI, 15.4-138.1). Only 1 study directly compared the yield of SpyBite biopsies with standard brushings and biopsies. SpyBite biopsies had a sensitivity of 76.5% compared with brushings (5.8%) and biopsies (29.4%). Six studies specifically reported the role of cholangioscopy with targeted biopsies in the diagnosis of @entity201 . The pooled sensitivity and specificity to detect @entity201 was 66.2% (95% CI, 59.7%-72.3%) and 97.0% (95% CI, 94.0%-99.0%), respectively. The pooled DOR to detect @entity201 was 79.7 (95% CI, 32.7-194.7). CONCLUSIONS: Our study suggests that SpyGlass cholangioscopy with SpyBite biopsies has moderate sensitivity for the diagnosis of @entity5 .
