The greater quantity of tissue samples proved useful for both PSC and non-PSC patients. The biopsies showed significantly more inflammatory characteristics and greater inflammatory activity compared to the cytological investigation (P = 0.014). More tissue material was obtained for the biopsy method than for the brush cytology method (P = 0.021). In cases of inflammation of the biliary tract, the diagnostic yield of the SpyGlass(TM)-directed biopsies was greater than that using brush cytology. However, for both methods, tissues could only be retrieved from 29 patients. No procedure-related complications were encountered. Nineteen patients had known PSC, and 10 showed non-PSC strictures. The median patient age was 45 years (min, 20 years max, 76 years). SpyGlass(TM) imaging and brush cytology with material retrieval were performed in 29 of 31 (93.5%) patients (23 of the 29 patients were male). The specimen quantity was rated as low, moderate, or sufficient. Inflammatory changes were divided into three categories: none, low activity, and high activity. The study endpoints (for both techniques) were the degree of inflammation, tissue specimen size, and the patient populations (PSC vs non-PSC). The biliary tree was visualized, and suspected lesions or strictures were biopsied, followed by brush cytology of the same area.
The Boston Scientific SpyGlass System(TM) (Natick, MA, United States) was used for choledochoscopy. POC was performed later during the same session. Standard ERC was initially performed, and any lesions or strictures were localized. Thirty-one patients with non-PSC strictures or with PSC were scheduled to undergo endoscopic retrograde cholangiography (ERC) and subsequent peroral cholangioscopy (POC). All patients underwent a physical examination, lab analyses, and abdominal ultrasound. To evaluate the diagnostic yield (inflammatory activity) and efficiency (size of the biopsy specimen) of SpyGlass(TM)-guided biopsy vs standard brush cytology in patients with and without primary sclerosing cholangitis (PSC).Īt the University Medical Center Mainz, Germany, 35 consecutive patients with unclear biliary lesions (16 patients) or long-standing PSC (19 patients) were screened for the study.
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