Utility of Peroral Cholangioscopy in the Diagnosis and Management of Intraductal Papillary Neoplasms of the Bile Duct (With Videos)

초록

Background and Aims Intraductal papillary neoplasms of the bile duct (IPN-Bs), recognized as potential precursors of invasive cholangiocarcinoma, present diagnostic challenges due to their variable imaging characteristics, mucin production, and frequent tumor multiplicity. Conventional imaging modalities may be limited in accurately characterizing these lesions. We assessed the clinical utility of peroral cholangioscopy (POC) in the diagnosis and management of IPN-Bs.Methods IPN-Bs were diagnosed in consecutive patients who underwent POC, based on a comprehensive assessment of clinical presentation, laboratory findings, imaging studies, and POC results. The primary outcome was the detection rate of IPN-Bs. The secondary outcomes were the technical success of POC and POC-guided forceps biopsy (POC-FB), diagnostic accuracy of POC findings, procedure-related adverse events (AEs), detection rate of IPN-Bs missed on prior imaging, and management modification rate after POC.Results POC was completed in 599 of 631 patients (94.9%). Mild procedure-related AEs occurred in nine patients (1.4%) and were managed conservatively. IPN-Bs were identified in 84 patients (13.3%), including 25 (29.8%) that had not been detected on prior imaging. Among the 81 of 84 patients in whom POC-FB was successful, histopathologic diagnoses included indefinite for dysplasia (17.3%), low-grade dysplasia (53.1%), high-grade dysplasia (13.6%), and invasive carcinoma (16.0%). Among 59 patients with suspected IPN-Bs on conventional imaging, POC findings led to management modifications in 17 cases (20.2%).Conclusions POC is a useful diagnostic modality for the detection of IPN-Bs and facilitates accurate decision-making for subsequent management planning.

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