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

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.