Clinical characteristics of 74 patients with indeterminate biliary stricture treated by ERCP combined with SpyGlass DS
Objective To analyze the clinical data of patients with indeterminate biliary stricture(IBS)treated by endoscopic retrograde cholangiopancreatography(ERCP)combined with SpyGlass DS to provide more clinical data ref-erence for the treatment of IBS.Methods To review the clinical data of 74 patients with IBS treated by ERCP combined with SpyGlass DS at the Digestive Endoscopy Center of Dongfang Hospital,Beijing University of Chinese Medicine from Jan.2020 to Apr.2023,analyze the clinical characteristics of patients,summarize the assessment of benign and malig-nant strictures using SpyGlass DS direct visual impression,and summarize the results of SpyGlass DS-guided visual im-pression and SpyGlass DS-guided biopsy(SpyBite biopsy)performance characteristics in the diagnosis of IBS.Results A total of 74 patients with IBS,including 49 males and 25 females,aged(67±12)years(26-94 years),were included in this study.Sixty-one(82.4%)of the 74 patients were considered to have malignant stenosis under direct visualiza-tion,of which 40(65.6%)had a pathological diagnosis suggestive of malignancy,5(8.2%)had a pathological diagno-sis not suggestive of malignancy,and 16(26.2%)were not undergo biopsy.During follow-up,1 patient was diagnosed as malignant by imaging,while no progression was detected in the remaining patients.Thirteen(17.6%)SpyGlass DS stenoses were considered benign under direct visualization,of which 3(23.0%)were pathologically diagnosed as malig-nant,5(38.5%)were not pathologically diagnosed as malignant,and 5(38.5%)were not biopsied and no progres-sion was detected in any of the stenoses during follow-up.The percentage of SpyGlass DS direct visual impressions of tumor vascularity,hyperplasia,mucosal irregularity/nodular/proliferative changes,mucosal injury and biliary exudate with pathological diagnosis suggestive of malignancy were 24.4%,20.0%,62.2%,2.2%and 8.9%,respectively.The diagnostic sensitivity of SpyGlass DS direct visual impressions was 88.9%,with a specificity of 37.5%and accuracy of 81.1%,and the diagnostic sensitivity of SpyBite biopsy was 95.7%,with a specificity of 66.7%and accuracy of 92.3%.Conclusion ERCP combined with SpyGlass DS can be used for the diagnosis of IBS,which can greatly im-prove the disease confirmation rate.
Indeterminate biliary strictureERCPSpyGlass DSVisual impressionSpyBite direct visual biopsy
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