Cholangioscopy with narrow-band imaging in patients with primary sclerosing cholangitis undergoing ERCP

Background: Patients with primary sclerosing cholangitis (PSC) have an increased lifetime risk of cholangiocarcinoma (CCA). Detection of localized CCA in patients with PSC may result in curative liver transplantation. Recently, high-resolution per-oral video cholangioscopy (PVCS) has become available and may be useful for evaluating for biliary dysplasia. Narrow-band imaging (NBI) has shown promising results in detecting dysplasia in the esophagus and colon, but its utility in the bile duct is unproven. Objective: Evaluate NBI video PVCS in screening for dysplasia in patients with PSC. Design: Prospective case series. Setting: Tertiary-care referral center. Patients: Patients with PSC undergoing ERCP between December 2008 and July 2010. Intervention: ERCP with white-light and NBI PVCS and biopsy of suspicious lesions. Main Outcome Measurements: Dysplasia detection. Results: A total of 30 patients were enrolled. Median follow-up was 319.5 days. Four patients had a final diagnosis of CCA (2 extrahepatic, 2 intrahepatic). NBI visualized the 2 extrahepatic CCAs and allowed determination of tumor margins. The bile duct mucosa by NBI visual appearance in patients with PSC was variable. No correlation with CCA development could be determined. There was a 48% increase in suspicious lesions biopsied with NBI compared with white-light imaging, although NBI-directed biopsies did not improve the dysplasia detection rate. Limitations: Small sample size, single center, referral bias. Conclusion: NBI allowed visualization of tumor margins in CCA as compared with traditional fluoroscopy-based ERCP. An improvement in dysplasia detection in patients with PSC could not be demonstrated despite an increase in the biopsy rate. Additional experience is needed to assess the utility of NBI in screening for CCA in patients with PSC. (Clinical trial registration number: NCT00951327.)