J Korean Med Sci.  2008 Aug;23(4):579-585. 10.3346/jkms.2008.23.4.579.

The Usefulness of Percutaneous Transhepatic Cholangioscopy for Identifying Malignancies in Distal Commom Bile Duct Strictures

• Kim EH
• Kim HJ
• Oh HC
• Lee KH
• Jung JY
• Kim S
• Lee SS
• Seo DW
• Kim MH
• Lee SK

• KMID: 1785813
• DOI: http://doi.org/10.3346/jkms.2008.23.4.579

Abstract

The diagnostic accuracy of percutaneous transhepatic cholangioscopy (PTCS) was compared to that of three radiologic modalities in distal common bile duct (CBD) strictures for the evaluation of clinical application. Ninety-five patients who underwent PTCS for the evaluation of distal CBD strictures (35 malignant and 60 benign) whose masses were not obvious from radiologic imagings were included. Confirmative diagnosis could not be reached by endoscopic retrograde cholangiopancreatography (ERCP) or radiologic findings in all cases. Specific findings on the computed tomography (CT), magnetic resonance cholangiopancreatography (MRCP) and direct cholangiography were analyzed among 68 (25 malignant and 43 benign) out of the 95 patients in order to determine the sensitivity and specificity of three radiologic studies for the diagnosis of malignant distal CBD strictures, and to compare those results with those by a combination of PTCS-guided biopsy and tumor vessel observation on cholangioscopy. The sensitivity/specificity of CT, MRCP and direct cholangiography including ERCP in diagnosing malignant distal CBD strictures were 42.9%/65.8%, 53.3%/58.3%, and 70.8%/47.6% respectively, while it was 96%/100% for the combination of PTCS-guided biopsy and tumor vessel. PTCS is a useful method for differential diagnosis of distal CBD strictures, particularly when it is difficult to distinguish benign from malignant strictures by radiologic studies and when peroral approach is not feasible.

Keyword

Percutaneous; Cholangioscopy; Common Bile Duct; Stricture

MeSH Terms

Aged
Biopsy
Cholangiopancreatography, Magnetic Resonance
Common Bile Duct Diseases/*diagnosis/pathology
Common Bile Duct Neoplasms/*diagnosis/pathology
Constriction, Pathologic
Endoscopy, Digestive System/*methods
Endosonography
Female
Humans
Male
Middle Aged
Retrospective Studies
Sensitivity and Specificity