RESUMO
BACKGROUND: Single-operator peroral cholangioscopy (sPOCS) is considered a valuable diagnostic modality for indeterminate biliary strictures. Nevertheless, studies show large variation in its characteristics and measures of diagnostic accuracy. Our aim was to estimate the diagnostic accuracy of sPOCS visual assessment and targeted biopsies for indeterminate biliary strictures. Additional aims were: estimation of the clinical impact of sPOCS and comparison of diagnostic accuracy with brush cytology. METHODS: A retrospective single-center study of adult patients who underwent sPOCS for indeterminate biliary strictures was performed. Diagnostic accuracy was defined as sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The clinical impact of sPOCS was assessed by review of medical records, and classified according to its influence on patient management. RESULTS: 80 patients were included, with 40â% having primary sclerosing cholangitis (PSC). Prior ERCP was performed in 88â%, with removal of a biliary stent prior to sPOCS in 55â%. The sensitivity, specificity, PPV, and NPV for sPOCS visual impression and targeted biopsies were 64â%, 62â%, 41â%, and 84â%, and 15â%, 65â%, 75â%, and 69â%, respectively. The clinical impact of sPOCS was limited; outcome changed management in 17â% of patients. Sequential brush cytology sensitivity, specificity, PPV, and NPV were 47â%, 95â%, 80â%, and 83â%. CONCLUSIONS: The diagnostic accuracy of sPOCS for indeterminate biliary strictures was found to be inferior to brush cytology, with a low impact on patient management. These findings are obtained from a select patient population with a high prevalence of PSC and plastic stents in situ prior to sPOCS.