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Peroral cholangioscopy with cholangioscopy-directed biopsies in the diagnosis of biliary malignancies

a systemic review and meta-analysis

Badshah, Maaz B.b; Vanar, Vishwasb; Kandula, Manasaa; Kalva, Nikhilb; Badshah, Mashood B.f; Revenur, Vakyaa; Bechtold, Matthew L.d; Forcione, David G.d; Donthireddy, Kavithae; Puli, Srinivas R.b

European Journal of Gastroenterology & Hepatology: August 2019 - Volume 31 - Issue 8 - p 935–940
doi: 10.1097/MEG.0000000000001402
Original Articles: Gastroenterology

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 χ2 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.

Departments of aInternal Medicine

bGastroenterology, University of Illinois College of Medicine at Peoria, Peoria, Illinois

cDepartment of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts

dDepartment of Gastroenterology, University of Missouri, Columbia, Missouri

eDepartment of Hematology and Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA

fDepartment of Medicine, Khyber Medical University, Peshawar, Pakistan

Correspondence to Maaz B. Badshah, MD, Department of Gastroenterology, University of Illinois College of Medicine at Peoria, 5105 Glen Park Place, Peoria, IL 61614, USA Tel: +1 309 308 5900; fax: +1 309 308 5910; e-mail:

Received January 4, 2019

Received in revised form January 30, 2019

Accepted February 21, 2019

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