TY - JOUR
T1 - Efficacy of digital single-operator cholangioscopy in the visual interpretation of indeterminate biliary strictures
T2 - a systematic review and meta-analysis
AU - de Oliveira, Pedro Victor Aniz Gomes
AU - de Moura, Diogo Turiani Hourneaux
AU - Ribeiro, Igor Braga
AU - Bazarbashi, Ahmad Najdat
AU - Franzini, Tomazo Antonio Prince
AU - dos Santos, Marcos Eduardo Lera
AU - Bernardo, Wanderley Marques
AU - de Moura, Eduardo Guimarães Hourneaux
N1 - Publisher Copyright:
© 2020, Springer Science+Business Media, LLC, part of Springer Nature.
PY - 2020/8/1
Y1 - 2020/8/1
N2 - Objective: Indeterminate biliary strictures remain a significant diagnostic challenge. Digital single-operator cholangioscopy (D-SOC) incorporates digital imaging which enables higher resolution for better visualization and diagnosis of biliary pathology. We aimed to conduct a systematic review and meta-analysis of available literature in an attempt to determine the efficacy of D-SOC in the visual interpretation of indeterminate biliary strictures. Material and methods: Electronic searches were performed using Medline (PubMed), EMBASE, and Cochrane Library. All D-SOC studies that reported the diagnostic performance in visual interpretation of indeterminate biliary strictures and biliary malignancies were included. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 was used to evaluate the quality of the included studies. All data were extracted and pooled to construct a 2 × 2 table. The visual interpretation of D-SOC was compared to resected surgical specimens or clinical follow-up in the included patients. Pooled sensitivity, specificity, positive predictive value, negative predictive value, prevalence, positive likelihood ratio (+LR), negative likelihood ratio (−LR), and diagnostic odds ratio (OR) were calculated. The summarized receiver operating characteristic (SROC) curve corresponding with the area under the curve (AUC) was also analyzed. Results: The search yielded 465 citations. Of these, only six studies with a total of 283 procedures met inclusion criteria and were included in the meta-analysis. The overall pooled sensitivity and specificity of D-SOC in the visual interpretation of biliary malignancies was 94% (95% CI 89–97) and 95% (95%CI 90–98), respectively, while +LR, −LR, diagnostic OR, and AUC were 15.20 (95%CI 5.21–44.33), 0.08 (95%CI 0.04–0.14), 308.83 (95%CI 106.46–872.82), and 0.983, respectively. The heterogeneity among 6 included studies was moderate for specificity (I2 = 0.51) and low for sensitivity (I2 = 0.17) and diagnostic OR (I2 = 0.00). Conclusion: D-SOC is associated with high sensitivity and specificity in the visual interpretation of indeterminate biliary strictures and malignancies. D-SOC should be considered routinely in the diagnostic workup of indeterminate biliary lesions.
AB - Objective: Indeterminate biliary strictures remain a significant diagnostic challenge. Digital single-operator cholangioscopy (D-SOC) incorporates digital imaging which enables higher resolution for better visualization and diagnosis of biliary pathology. We aimed to conduct a systematic review and meta-analysis of available literature in an attempt to determine the efficacy of D-SOC in the visual interpretation of indeterminate biliary strictures. Material and methods: Electronic searches were performed using Medline (PubMed), EMBASE, and Cochrane Library. All D-SOC studies that reported the diagnostic performance in visual interpretation of indeterminate biliary strictures and biliary malignancies were included. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 was used to evaluate the quality of the included studies. All data were extracted and pooled to construct a 2 × 2 table. The visual interpretation of D-SOC was compared to resected surgical specimens or clinical follow-up in the included patients. Pooled sensitivity, specificity, positive predictive value, negative predictive value, prevalence, positive likelihood ratio (+LR), negative likelihood ratio (−LR), and diagnostic odds ratio (OR) were calculated. The summarized receiver operating characteristic (SROC) curve corresponding with the area under the curve (AUC) was also analyzed. Results: The search yielded 465 citations. Of these, only six studies with a total of 283 procedures met inclusion criteria and were included in the meta-analysis. The overall pooled sensitivity and specificity of D-SOC in the visual interpretation of biliary malignancies was 94% (95% CI 89–97) and 95% (95%CI 90–98), respectively, while +LR, −LR, diagnostic OR, and AUC were 15.20 (95%CI 5.21–44.33), 0.08 (95%CI 0.04–0.14), 308.83 (95%CI 106.46–872.82), and 0.983, respectively. The heterogeneity among 6 included studies was moderate for specificity (I2 = 0.51) and low for sensitivity (I2 = 0.17) and diagnostic OR (I2 = 0.00). Conclusion: D-SOC is associated with high sensitivity and specificity in the visual interpretation of indeterminate biliary strictures and malignancies. D-SOC should be considered routinely in the diagnostic workup of indeterminate biliary lesions.
KW - Biliary malignancies
KW - Cholangioscopy
KW - Diagnosis
KW - Indeterminate strictures
KW - Meta-analysis
KW - Spyglass
UR - http://www.scopus.com/inward/record.url?scp=85084156859&partnerID=8YFLogxK
U2 - 10.1007/s00464-020-07583-8
DO - 10.1007/s00464-020-07583-8
M3 - Review article
C2 - 32342216
AN - SCOPUS:85084156859
SN - 0930-2794
VL - 34
SP - 3321
EP - 3329
JO - Surgical endoscopy
JF - Surgical endoscopy
IS - 8
ER -