Digital single-operator video cholangioscopy improves endoscopic management in patients with primary sclerosing cholangitis-a retrospective observational study

Table 1 Characteristics of patients with primary sclerosing cholangitis undergoing digital single-operator video cholangioscopy

Variable	Patients (n = 38)
Primary sclerosing cholangitis, n (%)	38 (100)
Age (in years)	44.8 (± 2.1)
Male, n (%)	26 (68.4)
Female, n (%)	12 (31.6)
Liver cirrhosis, n (%)	20 (52.6)
Enlisted for liver transplantation, n (%)	11 (28.9)
Diagnosis of a cholangiocellular carcinoma, n (%)	4 (10.5)

Table 2 Basic analysis of digital single-operator video cholangioscopies performed in patients with primary sclerosing cholangitis

Variable	Digital SOVC (n = 46)
Type of digital SOVC
Initial examinations, n (%)	38 (82.6)
Repeated examinations, n (%)	8 (17.4)
Main indication for using SOVC
Stricture assessment, n (%)	37 (80.4)
Selective guidewire placement, n (%)	6 (13)
Cholangiolithiasis, n (%)	2 (4.3)
Others, n (%)	1 (2.2)
Clinical patient data before SOVC (multiple items permitted)
Prior papillotomy, n (%)	41 (89.1)
Elevated serum bilirubin level (> 1.2 mg/dl), n (%)	30 (65.2)
Prior post-ERC-pancreatitis, n (%)	10 (21.7)
Type of digital SOVC
ERC-based digital SOVC, n (%)	46 (100)
Total examination time (ERC + digital SOVC; min)	73 (± 5.2); n = 40/46
Dysfunction of the SOVC-system, n (%)	1 (2.2)
Procedures during SOVC-examination (multiple items permitted)
SOVC-assisted guidewire insertion, n (%)	39 (84.7)
SOVC-assisted forceps biopsies, n (%)	25 (54.3)
SOVC-assisted EHL, n (%)	2 (4.3)
Additive procedures during ERC-examination (multiple items permitted)
Balloon dilation of the biliary tract, n (%)	35 (76.1)
New papillotomy, n (%)	7 (15.2)
Conventional transpapillary biopsy, n (%)	6 (13.0)
Endoprosthesis placement, n (%)	5 (10.9)
Periinterventional application of drugs to prevent AE
Antibiotics, n (%)	46 (100)
NSAID (Diclofenac/Indomethacin), n (%)	6 (13)

SOVC: Single-operator video cholangioscopy; EHL: Electrohydraulic lithotripsy; AE: Adverse event; ERC: Endoscopic retrograde cholangiography; NSAID: Nonsteroidal anti-inflammatory drug.

Table 3 Evaluation of dominant biliary strictures in patients with primary sclerosing cholangitis using digital single-operator video cholangioscopy (n = 22)

Variable	Dominant strictures (n = 22)
Entity of dominant stricture, n (%)
Benign	18 (81.8)
Malignant	4 (18.2)
Localization of dominant stricture, n (%)
Intrahepatic	13 (59.1)
Extrahepatic	3 (13.6)
Intra- and extrahepatic crossing	6 (27.3)
Visual evaluation of stricture by endoscopists, n (%)
Suspicious for malignancy	4 (18.2)
Suspicious for benignancy	18 (81.8)
SOVC-guided forceps biopsies, n (%)
Carcinoma/high-grade dysplasia	2 (9.1)
Benign findings	10 (45.5)
Inadequate material	1 (4.5)

SOVC: Single-operator video cholangioscopy.

Table 4 Diagnostic efficacy of digital single-operator video cholangioscopy for diagnosing malignancy in dominant biliary strictures in patients with primary sclerosing cholangitis (n = 22; cholangioscopic-assisted visual evaluation, n = 22 and cholangioscopic-guided biopsies, n = 12)

Variable	Accuracy (%)	Sensitivity (%)	Specificity (%)	Pos. pred. value (%)	Neg. pred. value (%)
Visual evaluation (95%CI)	90.9 (72.8-99.2)	75 (25.2-97.8)	94.4 (83.4-99.5)	75 (25.2-97.8)	94.4 (83.4-99.5)
Histological evaluation (95%CI)	83.3 (57.2-83.3)	50 (10.8-50.0)	100 (80.4-100)	100 (21.7-100)	80 (64.3-80)

95%CI: 95% confidence interval; pos.: Positive; neg.: Negative; pred.: Predictive.

Table 5 Diagnosis and treatment of biliary stone disease and performance of selective guidewire placements across biliary strictures (with a previous failure of conventional endoscopic methods to pass a guidewire) using digital single-operator video cholangioscopy in patients with primary sclerosing cholangitis

Variable	Examinations (n = 46)
Cholangiolithiasis, n (%)	8/46 (17.3)
Localization
Extrahepatic, n (%)	3/8 (37.5)
Intrahepatic, n (%)	3/8 (37.5)
Intra- and extrahepatic, n (%)	2/8 (25)
Stone size (range)	3-20 mm
Stone number (range)	1-5
Treatment
Complete success (conventional ± EHL), n (%)	8/8 (100)
Success only via use of EHL, n (%)	2/8 (25)
Stone identification only via SOVC, n (%)	3/8 (37.5)
Selective guidewire insertion across biliary strictures, n (%)	6/46 (13)
Kind of procedures
Initial examinations, n (%)	5/6 (83.3)
Repeated examinations, n (%)	1/6 (16.7)
Technical success, n (%)	6/6 (100)

EHL: Electrohydraulic lithotripsy; SOVC: Single-operator video cholangioscopy.

Table 6 Safety data of digital single-operator video cholangioscopies in patients with primary sclerosing cholangitis

Variable	Digital SOVCs (n = 46)
Overall complications, n (%)	6 (13)
Pancreatitis, n (%)	3 (6.5)
Grade 1	0 (0)
Grade 2	2 (4.3)
Grade 3	1 (2.2)
Cholangitis, n (%)	3 (6.5)
Grade 1	0 (0)
Grade 2	3 (6.5)
Grade 3	0 (0)
Others (bleeding/perforation), n (%)	0 (0)
Procedure-related mortality, n (%)	0 (0)
Suspected prolonged hospital stay due to complications (in days)	6.5 (± 1.5)

SOVC: Single-operator video cholangioscopy.