The Role of Cholangioscopy in the Management of Primary Sclerosing Cholangitis

AbstractPurpose of ReviewPrimary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease characterized by inflammation and fibrosis of the biliary ducts associated with a high risk for hepatobiliary malignancies. Up to 50% of PSC patients develop dominant strictures (DS) and warrant investigations to exclude cholangiocarcinoma (CCA). Most patients undergo endoscopic retrograde cholangiopancreatography (ERCP) with brush cytology, but diagnostic accuracy is suboptimal, with sensitivity varying between 8 and 43% for the detection of CCA. Negative brush cytology often results in repeat ERCPs and need for heightened surveillance.Recent FindingsThe relatively recent introduction of per oral single operator cholangioscopy (SOC) as a safe and efficient complementary tool to ERCP allows for visual characterization and direct targeted forceps biopsy acquisition, with some studies showing sensitivity of up to 90% for overall diagnostic performance. However, most of the data for SOC in PSC comes from retrospective single-center studies.SummarySOC allows visual characterization and direct targeted biopsies, with some studies demonstrating superior diagnostic performance for CCA detection in PSC. In addition, SOC may have potential benefit in characterization of different phenotypes of DS in PSC.
Source: Current Hepatitis Reports - Category: Infectious Diseases Source Type: research