A Comparative Study On The Application Of Different Endoscopic Methods In The Differential Diagnosis Of Benign And Malignant Biliary Stricture

Objective:To investigate and compare the application value of transpapillary biopsy 、ERCP-guided brushing 、 Spybite 、 SpyGlass visual interpretation and IDUS for indeterminate biliary strictures.Methods:The clinical data of patients who visited our hospital between January 2010 and December 2019 with a diagnosis of consideration of unexplained biliary stricture with bile duct brushing,biopsy,IDUS,and SpyGlass were collected and analyzed to study.By evaluating the final diagnostic criteria of surgical pathological diagnosis and clinical follow-up(Malignant stenosis is identified as malignant progression during 1 year of follow-up).Transpapillary biopsy,ERCP-guided brushing,IDUS,Spybite,Spyglass visual interpretation were evaluated by sensitivity,specificity,positive predictive value,negative predictive value,accuracy,missed diagnosis rate,misdiagnosis rate and complication rate for The diagnostic value of bile duct benign and malignant strictures.Results:In terms of sensitivity,biopsy(48.55%)was significantly higher than the ERCP-guided brushing(31.95%),and SpyGlass visual interpretation(100%)was significantly higher than ERCP-guided brushing(31.95%),biopsy(48.55%),and Spybite(61.54%).IDUS(100%)was significantly higher than ERCP-guided brushing(31.95%),and there was no statistical difference among the other groups.As for specificity,ERCP-guided brushing(98.97%)was significantly higher than SpyGlass visual interpretation(55.56%)and IDUS(0%),and biopsy(99.26%)was significantly higher than SpyGlass visual interpretation(55.56%)and IDUS(0%).Spybite(100%)was significantly higher than SpyGlass visual interpretation(55.56%),and there was no statistical difference between the other groups.As for accuracy,ERCP-guided brushing(44.17%)was significantly lower than biopsy(65.59%),Spybite(80%)and SpyGlass visual interpretation(80.95%),and there was no statistical difference between the other groups.Regarding the positive predictive value,SpyGlass visual interpretation(75%)was significantly lower than ERCP-guided brushing(99.29%)and biopsy(99.26%),and there was no statistical difference between the other groups.As for the negative predictive value,ERCP-guided brushing(24.49%)was significantly lower than biopsy(48.74%),Spybite(70.59%)and SpyGlass visual interpretation(100%),and there was no statistical difference between the other groups.Complications of ERCP include post-ERCP pancreatitis,hyperamylasemia,cholangitis,cholecystitis,bleeding,and perforation.The incidence of hyperamy-lasemia in ERCP-guided brushing(8.65%)and biopsy(6.07%)was significantly higher than Spybite(0%)and SpyGlass visual interpretation(0%),and there was no statistical difference among the other groups.As for the incidence of postoperative cholangitis,biopsy(4.37%)was significantly lower than Spybite(24%),SpyGlass visual interpretation(19.35%)and IDUS(25%),and there was no statistical difference between the other groups.There were no significant differences in the incidence of postoperative pancreatitis,cholecystitis,hemorrhage and perforation among all groups.Conclusion:As for the diagnostic value,Spybite,SpyGlass visual interpretation,and IDUS improved in sensitivity and accuracy compared to ERCP-guided brushing and biopsy in patients with unexplained bile duct strictures.From the perspective of safety,SpyGlass,SpyGlass visual interpretation show a higher incidence of postoperative cholangitis,with no significant differences in postoperative pancreatitis,bleeding,or perforation.