Awadallah NS et al. (2006) Is there a role for cholangioscopy in patients with primary sclerosing cholangitis? Am J Gastroenterol 101: 284–291

Primary sclerosing cholangitis (PSC) is associated with an increased risk of cholangiocarcinoma. Awadallah et al. investigated whether the use of cholangioscopy, which allows direct visualization of the biliary tree, adds any advantage to conventional biopsy techniques in the detection of cholangiocarcinoma in patients with PSC. They also assessed its usefulness in the detection and removal of biliary stones.

The study included 41 consecutive patients with PSC (30 male) referred between March 2000 and November 2004 for cholangioscopic evaluation of biliary strictures or stones. Biopsies were taken of lesions visualized by cholangioscopy in 33 patients: cholangiocarcinoma was found in only 1 patient. During follow-up, two further patients were discovered to have cholangiocarcinomas that had not been detected by cholangioscopy. These two patients were examined using pre-existing percutaneous tracts, however, and this might have limited visualization of the biliary tree. Cholangioscopy detected stones in more patients than conventional cholangiography did (23 versus 16). Stone clearance was not attempted in 6/23 patients; of the remaining 17, 9 were treated with cholangioscopy-assisted methods and 8 with conventional methods. Complete clearance was achieved in 7 and 3 patients, respectively.

The authors conclude that cholangioscopy-assisted techniques might be more effective than conventional techniques in detecting biliary stones and achieving complete stone clearance; however, the small number of patients in this study with cholangiocarcinoma precludes any conclusions being drawn about its usefulness in the detection of cancer in PSC.