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Bile Duct LesionsNCT02794987

Cholangioscopic Classification of Bile Duct Lesions

An observational study of Bile Duct Lesions, run by Instituto Ecuatoriano de Enfermedades Digestivas at 1 site in Ecuador.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Endoscopic retrograde cholangio-pancreatography (ERCP) is a diagnostic and therapeutic procedure, however it has an important image limitation. The fluoroscopic cholangiography shows the biliary tree in a two-dimensional view. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Bile Duct Lesions
What is being tested?
SpyGlass® choledoscopy
Type of treatment
Medical device
How many people
130 participants
Where
1 siteEcuador
Study dates
Dec 2015to Dec 2016
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Study population: Stage 1: 63 patients enrolled with bile duct tissular lesion detected by POCS. Cholangioscopic lesions images (315) were compared to histopathology results and 6 months follow up with POCS, and an experienced endoscopist with more than 140 POCS performed a POCS macroscopic classification of tissular bile duct lesions, based on the morphological and vascular pattern. Stage 2: estimated enrollment of 100 patients with bile duct tissular lesion detected by POCS. Patients included will be analyzed by two groups of endoscopists. One group (action group) will use the previous classification to select the images as benign or malignant with the different subtypes; and the second group (control group) will do it without using the classification.

Who may be able to join

  • Above 18 years old patients
  • Who agree to participate in the study
  • Patients with tissular biliary lesions detected by POCS

Who cannot join

  • Tissular lesions with no histology confirmation (either biopsy or surgical resection in case of malignancy suspicion) or 6 months follow-up by POCS (in case of benign suspicion)
  • Severe uncontrolled coagulopathy
  • Esophageal, gastric or duodenal stenosing tumors with no possibility of scope passage
  • Prior history of esophageal, gastric or surgery with no possibility of scope passage
  • Contrast allergy
  • Pregnancy and lactation

Trial locations and contacts

1 site in 1 country.

Ecuador1 site
  • Instituto Ecuatoriano de Enfermedades Digestivas, Omnihospital

    Guayaquil, Guayas, 090505

Other trials in Ecuador

About this study

Official title: Proposal of a Macroscopic Classification for Tissular Lesions of the Bile Duct Detected During Per Oral Cholangioscopy (POCS)

Endoscopic retrograde cholangio-pancreatography (ERCP) is a diagnostic and therapeutic procedure, however it has an important image limitation. The fluoroscopic cholangiography shows the biliary tree in a two-dimensional view. When an indeterminate biliary stricture is seen, the certainly diagnosis by ERCP depends on a blind biopsy sampling with the risk of missed pathology and sampling errors. SpyGlass® System (Boston Scientific, Marlborough, Massachusetts, USA) is a cholangioscope that enables single-operator, direct visualization of the pancreatico-biliary system and the evaluation of intraductal lesions. It has a digital sensor with 4x resolution and a 1.2 mm working channel that allows the passage of the SpyBite® Forceps biopsy. It has been demonstrated that the use of SpyGlass® System and SpyBite® Forceps changes clinical management in 64% of patients. It has a sensitivity of 76.5% for indeterminate stricture diagnosis, compared to 29.4% and 5.9% sensitivity using blind biopsy brushing catheter respectively. Although it has been described before cholangioscopic images of malignant biliary lesions like an irregular lesion surface with irregular vessels and bleeding or a smooth surface without vessels for benign lesions, there is no current validated classification that allows unify the diagnostic criteria.

Methods: Study design: The study was design to be performed in 2 stages. Stage 1: observational, retrospective study with case collection from September 2013 to September 2015. Patients included had bile duct tissular lesion detected by POCS. The images were correlated to histopathology and 6 month follows up and a classification was finally performed to differentiate benign forma malignant bile duct lesions. Stage 2: patients with bile duct tissular lesion detected by POCS, will be the evaluated in a prospective, non-randomized and double blind manner. Two groups of endoscopist will evaluate the images but only one group will do it using the classification previously performed. Second stage case collection has already started (December 2015) and will include patients until December 2016.

  • Endpoint Classification: Efficacy
  • Intervention Model: Non interventional
  • Primary Purpose: Diagnosis
Read the detailed description

Setting: Gastroenterology division of the Ecuadorian Institute of Digestive Diseases (IECED), OmniHospital Academic Tertiary Center. The study protocol and consent form has been approved by the Institutional Review Board and will be conducted according to the declaration of Helsinki. Patients will sign an informed consent.

Population selection:

Stage 1: 63 patients enrolled with bile duct tissular lesion detected by POCS. Cholangioscopic lesions images (315) were photographically recorded in order to correlate to, histopathology after targeted or surgical biopsies, and 6 months follow up with POCS. Using the histopathology results, the lesions were classified into benign or malignant. An experienced endoscopist with more than 140 POCS analyzed the images based on the morphological and vascular pattern and performed a POCS macroscopic classification of tissular bile duct lesions as follow: Benign lesions: Type 1 "Villous pattern" (micronodular or villous pattern without vascularity), Type 2 "Polypoid pattern" (adenoma or granuloma pattern without vascularity) and Type 3 "Inflammatory pattern" (regular or irregular fibrous and congestive pattern with regular vascularity). Malignant lesions: Type 1 "Flat pattern" (flat and smooth or irregular surface with irregular or spider vascularity); Type 2 "Polypoid pattern" (polypoid or mass shape with fibrosis and irregular or spider vascularity), Type 3 "Ulcerated pattern" (irregular ulcerated and infiltrative pattern with or without fibrosis and with irregular or spider vascularity) and type 4 "honey-comb pattern" (fibrous honey-comb pattern with or without irregular or spider vascularity).

Stage 2: estimated enrollment of 100 patients with bile duct tissular lesion detected by POCS. Patients included will be analyzed by two groups of endoscopists. One group (classification group) will use the previous classification to select the images as benign or malignant with the different subtypes; and the second group (no classification group or control group) will do it without using the classification.

Endoscopic technique:

Stage 1: patients included were evaluated using a standard duodenoscope (Pentax ED 3670TK, Hoya Co.), the Pentax Video Processor EPK-i5010 and both SpyGlass® cholangioscopes: First generation, SpyGlass® Direct Visualization System and Second generation, Digital SpyGlass® DS System (Boston Scientific, Marlborough, Massachusetts, USA) in a mother-baby manner. Procedures were performed by one experienced endoscopists with more than 300 ERCP/year (C.R.M), in the supine position and under general anesthesia. All patients received antibiotic prophylaxis. Biopsies were taken in order to correlate to histopathology.

Stage 2: patients will be evaluated using a standard duodenoscope (Pentax ED 3670TK, Hoya Co.), the Pentax Video Processor EPK-i7010 and second generation, Digital SpyGlass® DS System (Boston Scientific, Marlborough, Massachusetts, USA) in a mother-baby manner. Procedures will be performed by two experienced endoscopists with more than 300 ERCP/year (C.R.M and M.S.A), in the supine position and under general anesthesia. Half of patients will receive antibiotic prophylaxis because an ongoing cholangioscopic antibiotic prophylaxis protocol. Biopsies will be taken in order to correlate to histopathology.

Inter and intra-observer agreement Stage 1: A data set containing 40 random photographs of the bile duct lesions were presented to 1 expert and 2 non-experts in POCS, whom analyzed the images blindly. Intra and inter-observer reproducibility was measure based on comparison of images between endoscopists.

Stage 2: Intra and inter-observer agreement will be performed in the same manner as stage1.

Statistical analysis: Baseline characteristics will be compared between groups using Chi-square o Fisher Test for categorical variable and Mann-Whitney Test for continuing variables. Accuracy, sensitive, specificity, positive and negative predicts value will be calculated. To examine inter and intra observer agreement, kappa values will be calculated. A P value of less than 0.05 is considered to be statistically significant. All the statistical analysis will be performed using SPSS software suite v.22.

Limitations: the protocol will be performed in only one center.

Being tested
SpyGlass® choledoscopy
Keywords
Bile duct, indeterminate stricture, cholangioscopy, Spyglass

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • SpyGlass® choledoscopyDevice

    Stage 1: patients included were evaluated using a standard duodenoscope and both SpyGlass® cholangioscopes: First generation, SpyGlass® Direct Visualization System and Second generation, Digital SpyGlass® DS System (Boston Scientific, Marlborough, Massachusetts, USA) Procedures were performed by one experienced endoscopists with more than 300 ERCP/year (C.R.M). Biopsies were taken in order to correlate to histopathology. Stage 2: patients will be evaluated using a standard duodenoscope and second generation, Digital SpyGlass® DS System (Boston Scientific, Marlborough, Massachusetts, USA). Procedures will be performed by two experienced endoscopists with more than 300 ERCP/year (C.R.M and M.S.A). Biopsies will be taken in order to correlate to histopathology.

Study groups in NCT02794987
Study groupRoleWhat they receive
Classification groupGroup of endoscopists that will use the previous classification to select the bile duct tissular lesion images detected by SpyGlass® choledoscopy as benign or malignant with the different subtypes
Receives: Device: SpyGlass® choledoscopy
No classification groupGroup of endoscopists that will classified the bile duct tissular lesion images detected by SpyGlass® choledoscopy as benign or malignant with the different subtypes without using the classification.
Receives: Device: SpyGlass® choledoscopy

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Evaluation of vascular and surface features of benign and malignant lesions detected by POCS images, that could be used to perform a macroscopic classification of bile duct tissular lesions

    Vascular and surface features were analyzed using POCS images of bile duct lesions and were correlated to histopathology and 6 month follows up. Finally a classification differenciating benign from malignant bile duct lesions, was performed.

    Measured: 24 month

  2. The accuracy, sensitivity, specificity, positive and negative predictive value of the macroscopic classification will be measure in order to perform a prospective validation of the classification.

    The images of bile duct lesions will be evaluated by two groups of endoscopists but only one will do it using the previously designed classification. Diagnostic accuracy, sensitivity, specificity, positive and negative predictive value will be measure and compared between groups.

    Measured: 12 month

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted9 Jun 2016 (estimated)
  2. Study startDec 2015
  3. Primary completionDec 2016
  4. Study completionDec 2016

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Case crossover
Time perspective
Prospective
Enrolment
130 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02794987
Sponsor's protocol ID
MAY-1-2016
Status last verified
Dec 2016
First submitted
1 May 2016
Last updated
21 Dec 2016
Results posted
No
Data monitoring committee
Yes
Individual data sharing
Yes

Publications

  • Seelhoff A, Schumacher B, Neuhaus H. Single operator peroral cholangioscopic guided therapy of bile duct stones. J Hepatobiliary Pancreat Sci. 2011 May;18(3):346-9. doi: 10.1007/s00534-010-0360-7.

    PubMed 21480000
  • Tieu AH, Kumbhari V, Jakhete N, Onyimba F, Patel Y, Shin EJ, Li Z. Diagnostic and therapeutic utility of SpyGlass((R)) peroral cholangioscopy in intraductal biliary disease: single-center, retrospective, cohort study. Dig Endosc. 2015 May;27(4):479-485. doi: 10.1111/den.12405. Epub 2014 Dec 11.

    PubMed 25394296
  • Draganov PV, Lin T, Chauhan S, Wagh MS, Hou W, Forsmark CE. Prospective evaluation of the clinical utility of ERCP-guided cholangiopancreatoscopy with a new direct visualization system. Gastrointest Endosc. 2011 May;73(5):971-9. doi: 10.1016/j.gie.2011.01.003. Epub 2011 Mar 17.

    PubMed 21419408
  • Chen YK, Parsi MA, Binmoeller KF, Hawes RH, Pleskow DK, Slivka A, Haluszka O, Petersen BT, Sherman S, Deviere J, Meisner S, Stevens PD, Costamagna G, Ponchon T, Peetermans JA, Neuhaus H. Single-operator cholangioscopy in patients requiring evaluation of bile duct disease or therapy of biliary stones (with videos). Gastrointest Endosc. 2011 Oct;74(4):805-14. doi: 10.1016/j.gie.2011.04.016. Epub 2011 Jul 18.

    PubMed 21762903
  • Draganov PV, Chauhan S, Wagh MS, Gupte AR, Lin T, Hou W, Forsmark CE. Diagnostic accuracy of conventional and cholangioscopy-guided sampling of indeterminate biliary lesions at the time of ERCP: a prospective, long-term follow-up study. Gastrointest Endosc. 2012 Feb;75(2):347-53. doi: 10.1016/j.gie.2011.09.020.

    PubMed 22248602
  • Robles-Medranda C, Valero M, Soria-Alcivar M, Puga-Tejada M, Oleas R, Ospina-Arboleda J, Alvarado-Escobar H, Baquerizo-Burgos J, Robles-Jara C, Pitanga-Lukashok H. Reliability and accuracy of a novel classification system using peroral cholangioscopy for the diagnosis of bile duct lesions. Endoscopy. 2018 Nov;50(11):1059-1070. doi: 10.1055/a-0607-2534. Epub 2018 Jun 28.

    PubMed 29954008

Questions about this trial

What is this clinical trial studying?

An observational study of Bile Duct Lesions, run by Instituto Ecuatoriano de Enfermedades Digestivas at 1 site in Ecuador.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 21 Dec 2016. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Ecuador. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Evaluation of vascular and surface features of benign and malignant lesions detected by POCS images, that could be used to perform a macroscopic classification of bile duct tissular lesions (time frame: 24 month). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02794987, which also lists 6 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 21 Dec 2016.

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