Peroral cholangioscopic diagnosis of biliary-tract diseases by using narrow-band imaging (with videos)

Abstract

Background: Narrow-band imaging (NBI) makes it possible to emphasize the imaging of certain features, such as mucosal structures and mucosal microvessels in GI-tract diseases. Recently, video peroral cholangioscopy (POCS) was developed as a diagnostic modality for better visualization of bile-duct lesions; however, there is no report on POCS by using NBI.

Objective: To evaluate the clinical usefulness of POCS by using NBI for the diagnosis of biliary-tract diseases.

Design: Prospective case study.

Setting: This procedure was performed at Tokyo Medical University Hospital.

Patients: Twelve consecutive patients with biliary-tract diseases, including 7 bile-duct cancers and 5 benign biliary diseases, which revealed 6 bile-duct strictures and 6 filling defects by ERCP.

Intervention: All patients underwent POCS by using NBI.

Main outcome measurement: Efficacy and safety of this technique.

Results: Twenty-one lesions were evaluated by using POCS with conventional white light imaging and NBI. Although visualization of only 2 lesions (9.5%) was "excellent" by conventional observation, visualization of 12 lesions (57.4%) was "excellent" by NBI observation. Identification of the surface structure and vessels of the lesions by NBI observation was significantly better than with conventional observation (P < .01 and P < .05, respectively).

Limitations: Maneuverability and fragility of POCS. The current POCS is not equipped with magnification.

Conclusions: POCS by using NBI may be helpful for the observation of both fine mucosal structures and tumor vessels.