Clinical practice guideline on the use of single-operator cholangioscopy in the diagnosis of indeterminate biliary stricture and the treatment of difficult biliary stones

Adriana Margarita Rey Rubiano^{1

2}, Laura Yuriko González-Teshima¹, Lázaro Arango^{3

4

5}, Camilo Blanco-Avellaneda^{6

7

8}, Jhon Jaime Carvajal Gutiérrez^{9

10}, Rodrigo Castaño-Llano^{11

12}, Martin Alonso Gómez Zuleta^{13

14}, Carlos González^{15

16

17}, Arecio Peñaloza-Ramírez^{18

19}, Raúl Pinilla Morales^{20

21}, Renzo Pinto Carta^{22

23}, Héctor Adolfo Polanía Liscano^{24

25}, Reinaldo Andrés Rincón Sánchez^{26

27}, Mauricio Sepúlveda Copete²², Rómulo Vargas-Rubio²⁸, Camilo Andrés Avendaño Capriles^{29

30}, Andrés Mauricio García-Sierra^{1

31}, Juan José Yepes-Nuñez^{32

33

34}

Affiliations

¹ School of Medicine, Universidad de los Andes, Carrera 1 # 18a-12, Bogotá, D.C., Colombia.
² Department of Gastroenterology, Fundación Santa Fe de Bogotá, Bogotá, D.C., Colombia.
³ Department of Clinical Surgical Gastroenterology, University of Caldas, Manizales, Caldas, Colombia. lazaro.arango.m@gmail.com.
⁴ Department of Endoscopy and Gastroenterology, University of Caldas, Manizales, Caldas, Colombia. lazaro.arango.m@gmail.com.
⁵ Union of surgeons, Zentria Group, Manizales, Caldas, Colombia. lazaro.arango.m@gmail.com.
⁶ Department of Gastrointestinal Surgery and Digestive Endoscopy, Pontificia Universidad Javeriana, Bogotá, D.C, Colombia.
⁷ Education and Research Group, Faculty of Education, Universidad El Bosque, Bogotá, D.C., Colombia.
⁸ Videoendoscopy Unit of Restrepo Ltda, Bogotá, D.C, Colombia.
⁹ Department of Gastroenterology, Hospital Pablo Tobón Uribe, Medellín, Antioquia, Colombia.
¹⁰ Department of Internal Medicine, Universidad de Antioquia, Medellín, Antioquia, Colombia.
¹¹ Department of Gastroenterology, Universidad de Antioquia, Medellín, Antioquia, Colombia.
¹² Institute of Cancerology, Clínica las Américas Auna, Medellín, Antioquia, Colombia.
¹³ Department of Internal Medicine, Universidad Nacional de Colombia, Bogotá, D.C., Colombia.
¹⁴ Department of Internal Medicine, Gastroenterology Section, Hospital Universitario Nacional de Colombia, Bogotá, D.C., Colombia.
¹⁵ Department of Gastroenterology and Digestive Endoscopy, Clínica Reina Sofia, Bogotá, D.C., Colombia.
¹⁶ Department of Gastroenterology and Digestive Endoscopy, Fundación Universitaria Sanitas, Bogotá, D.C., Colombia.
¹⁷ Department of Gastroenterology, Clínica Colombia, Bogotá, D.C., Colombia.
¹⁸ Department of Gastroenterology, Fundación Universitaria de Ciencias de la Salud, Bogotá, D.C., Colombia.
¹⁹ Department of Gastroenterology, Hospital de San José, Bogotá, D.C., Colombia.
²⁰ Department of Gastroenterology and Oncological Digestive Endoscopy, Instituto Nacional de Cancerología, Bogotá, D.C., Colombia.
²¹ School of Medicine, Universidad Nacional de Colombia, Bogotá, D.C., Colombia.
²² Colombian Association of Digestive Endoscopy, Bogotá, D.C., Colombia.
²³ American Society for Gastrointestinal Endoscopy, Rochester, USA.
²⁴ Department of Gastroenterology, Universidad Surcolombiana, Neiva, Huila, Colombia.
²⁵ Endotek Ltda, Hospital Universitario Neiva, Neiva, Huila, Colombia.
²⁶ Department of Internal Medicine and Gastroenterology, Pontificia Universidad Javeriana - Hospital Universitario San Ignacio, Bogotá, D.C., Colombia.
²⁷ Department of Gastroenterology, Fundación Clínica Shaio, Bogotá, D.C., Colombia.
²⁸ Department of Gastroenterology, Hospital Universitario de San Ignacio, Pontificia Universidad Javeriana, Bogotá, D.C., Colombia.
²⁹ School of Medicine, Universidad del Norte, Barranquilla, Colombia.
³⁰ Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
³¹ School of Global Health Management and Informatics, University of Central Florida, Orlando, USA.
³² School of Medicine, Universidad de los Andes, Carrera 1 # 18a-12, Bogotá, D.C., Colombia. jj.yepesn@uniandes.edu.co.
³³ Pulmonology Service, Internal Medicine Section, Fundación Santa Fe de Bogotá University Hospital, Bogotá, D.C., Colombia. jj.yepesn@uniandes.edu.co.
³⁴ Colombia GRADE Network, Bogotá, D.C., Colombia. jj.yepesn@uniandes.edu.co.

PMID: 38148404
PMCID: PMC10830582
DOI: 10.1007/s00464-023-10569-x

Practice Guideline

Clinical practice guideline on the use of single-operator cholangioscopy in the diagnosis of indeterminate biliary stricture and the treatment of difficult biliary stones

Adriana Margarita Rey Rubiano et al. Surg Endosc. 2024 Feb.

. 2024 Feb;38(2):499-510.

doi: 10.1007/s00464-023-10569-x. Epub 2023 Dec 26.

Authors

Affiliations

¹ School of Medicine, Universidad de los Andes, Carrera 1 # 18a-12, Bogotá, D.C., Colombia.
² Department of Gastroenterology, Fundación Santa Fe de Bogotá, Bogotá, D.C., Colombia.
³ Department of Clinical Surgical Gastroenterology, University of Caldas, Manizales, Caldas, Colombia. lazaro.arango.m@gmail.com.
⁴ Department of Endoscopy and Gastroenterology, University of Caldas, Manizales, Caldas, Colombia. lazaro.arango.m@gmail.com.
⁵ Union of surgeons, Zentria Group, Manizales, Caldas, Colombia. lazaro.arango.m@gmail.com.
⁶ Department of Gastrointestinal Surgery and Digestive Endoscopy, Pontificia Universidad Javeriana, Bogotá, D.C, Colombia.
⁷ Education and Research Group, Faculty of Education, Universidad El Bosque, Bogotá, D.C., Colombia.
⁸ Videoendoscopy Unit of Restrepo Ltda, Bogotá, D.C, Colombia.
⁹ Department of Gastroenterology, Hospital Pablo Tobón Uribe, Medellín, Antioquia, Colombia.
¹⁰ Department of Internal Medicine, Universidad de Antioquia, Medellín, Antioquia, Colombia.
¹¹ Department of Gastroenterology, Universidad de Antioquia, Medellín, Antioquia, Colombia.
¹² Institute of Cancerology, Clínica las Américas Auna, Medellín, Antioquia, Colombia.
¹³ Department of Internal Medicine, Universidad Nacional de Colombia, Bogotá, D.C., Colombia.
¹⁴ Department of Internal Medicine, Gastroenterology Section, Hospital Universitario Nacional de Colombia, Bogotá, D.C., Colombia.
¹⁵ Department of Gastroenterology and Digestive Endoscopy, Clínica Reina Sofia, Bogotá, D.C., Colombia.
¹⁶ Department of Gastroenterology and Digestive Endoscopy, Fundación Universitaria Sanitas, Bogotá, D.C., Colombia.
¹⁷ Department of Gastroenterology, Clínica Colombia, Bogotá, D.C., Colombia.
¹⁸ Department of Gastroenterology, Fundación Universitaria de Ciencias de la Salud, Bogotá, D.C., Colombia.
¹⁹ Department of Gastroenterology, Hospital de San José, Bogotá, D.C., Colombia.
²⁰ Department of Gastroenterology and Oncological Digestive Endoscopy, Instituto Nacional de Cancerología, Bogotá, D.C., Colombia.
²¹ School of Medicine, Universidad Nacional de Colombia, Bogotá, D.C., Colombia.
²² Colombian Association of Digestive Endoscopy, Bogotá, D.C., Colombia.
²³ American Society for Gastrointestinal Endoscopy, Rochester, USA.
²⁴ Department of Gastroenterology, Universidad Surcolombiana, Neiva, Huila, Colombia.
²⁵ Endotek Ltda, Hospital Universitario Neiva, Neiva, Huila, Colombia.
²⁶ Department of Internal Medicine and Gastroenterology, Pontificia Universidad Javeriana - Hospital Universitario San Ignacio, Bogotá, D.C., Colombia.
²⁷ Department of Gastroenterology, Fundación Clínica Shaio, Bogotá, D.C., Colombia.
²⁸ Department of Gastroenterology, Hospital Universitario de San Ignacio, Pontificia Universidad Javeriana, Bogotá, D.C., Colombia.
²⁹ School of Medicine, Universidad del Norte, Barranquilla, Colombia.
³⁰ Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
³¹ School of Global Health Management and Informatics, University of Central Florida, Orlando, USA.
³² School of Medicine, Universidad de los Andes, Carrera 1 # 18a-12, Bogotá, D.C., Colombia. jj.yepesn@uniandes.edu.co.
³³ Pulmonology Service, Internal Medicine Section, Fundación Santa Fe de Bogotá University Hospital, Bogotá, D.C., Colombia. jj.yepesn@uniandes.edu.co.
³⁴ Colombia GRADE Network, Bogotá, D.C., Colombia. jj.yepesn@uniandes.edu.co.

PMID: 38148404
PMCID: PMC10830582
DOI: 10.1007/s00464-023-10569-x

Abstract

Background and aims: Single-operator cholangioscopy (SOC) offer a diagnostic and therapeutic alternative with an improved optical resolution over conventional techniques; however, there are no standardized clinical practice guidelines for this technology. This evidence-based guideline from the Colombian Association of Digestive Endoscopy (ACED) intends to support patients, clinicians, and others in decisions about using in adults the SOC compared to endoscopic retrograde cholangiopancreatography (ERCP), to diagnose indeterminate biliary stricture and to manage difficult biliary stones.

Methods: ACED created a multidisciplinary guideline panel balanced to minimize potential bias from conflicts of interest. Universidad de los Andes and the Colombia Grading of Recommendations Assessment, Development and Evaluation (GRADE) Network supported the guideline-development process, updating and performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The GRADE approach was used, including GRADE Evidence-to-Decision frameworks.

Results: The panel agreed on one recommendation for adult patients with indeterminate biliary strictures and one for adult patients with difficult biliary stones when comparing SOC versus ERCP.

Conclusion: For adult patients with indeterminate biliary strictures, the panel made a conditional recommendation for SOC with stricture pattern characterization over ERCP with brushing and/or biopsy for sensitivity, specificity, and procedure success rate outcomes. For the adult patients with difficult biliary stones the panel made conditional recommendation for SOC over ERCP with large-balloon dilation of papilla. Additional research is required on economic estimations of SOC and knowledge translation evaluations to implement SOC intervention in local contexts.

Keywords: Bile duct diseases; Biliary tract surgical procedures; Clinical practice guideline; GRADE approach.

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Conflict of interest statement

Martin Alonso Gómez Zuleta reported conflict of interest due to his business relationship with one of the manufacturers of the cholangioscopy equipment. Martin Alonso Gómez Zuleta participated in all the deliberation meetings on outcomes and recommendations; however, he abstained from voting to define the recommendations of this guideline. Please refer to Supplementary materials 1 and 2 for a detailed explanation of the expert panel, the reviewer team, and the conflict-of-interest declaration for each panel member. Adriana Margarita Rey Rubiano, Laura Yuriko González-Teshima, Lázaro Arango, Camilo Blanco-Avellaneda, Jhon Jaime Carvajal Gutiérrez, Rodrigo Castaño-Llano, Carlos González, Arecio Peñaloza-Ramírez, Raúl Pinilla Morales, Renzo Pinto Carta, Héctor Adolfo Polanía Liscano, Reinaldo Andrés Rincón Sánchez, Mauricio Sepúlveda Copete, Rómulo Vargas-Rubio, Camilo Andrés Avendaño Capriles, Andrés Mauricio García Sierra and Juan José Yepes-Nuñez have no conflict of interest to disclose.

References

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Clinical practice guideline on the use of single-operator cholangioscopy in the diagnosis of indeterminate biliary stricture and the treatment of difficult biliary stones

Affiliations

Clinical practice guideline on the use of single-operator cholangioscopy in the diagnosis of indeterminate biliary stricture and the treatment of difficult biliary stones

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources