Probe-based confocal laser endomicroscopy for indeterminate biliary strictures: Refinement of the image interpretation classification

Michel Kahaleh, Marc Giovannini, Priya Jamidar, S. Ian Gan, Paola Cesaro, Fabrice Caillol, Bernard Filoche, Kunal Karia, Ioana Smith, Monica Gaidhane, Adam Slivka

Research output: Contribution to journalArticlepeer-review

24 Scopus citations


Background. Accurate diagnosis and clinical management of indeterminate biliary strictures are often a challenge. Tissue confirmation modalities during Endoscopic Retrograde Cholangiopancreatography (ERCP) suffer from low sensitivity and poor diagnostic accuracy. Probe-based confocal laser endomicroscopy (pCLE) has been shown to be sensitive for malignant strictures characterization (98%) but lacks specificity (67%) due to inflammatory conditions inducing false positives. Methods. Six pCLE experts validated the Paris Classification, designed for diagnosing inflammatory biliary strictures, using a set of 40 pCLE sequences obtained during the prospective registry (19 inflammatory, 6 benign, and 15 malignant). The 4 criteria used included (1) multiple thin white bands, (2) dark granular pattern with scales, (3) increased space between scales, and (4) thickened reticular structures. Interobserver agreement was further calculated on a separate set of 18 pCLE sequences. Results. Overall accuracy was 82.5% (n = 40 retrospectively diagnosed) versus 81% (n = 89 prospectively collected) for the registry, resulting in a sensitivity of 81.2% (versus 98% for the prospective study) and a specificity of 83.3% (versus 67% for the prospective study). The corresponding interobserver agreement for 18 pCLE clips was fair (k = 0.37). Conclusion. Specificity of pCLE using the Paris Classification for the characterization of indeterminate bile duct stricture was increased, without impacting the overall accuracy.

Original languageEnglish (US)
Article number675210
JournalGastroenterology Research and Practice
StatePublished - 2015
Externally publishedYes

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology


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