Cholangioscopy or Conventional Techniques for Indeterminate Biliary Stenosis
Comparison of Two Diagnostic Strategies in Indeterminate Biliary Stenosis: Exploration by Retrograde Cholangioscopy From the Outset or After Failure of Conventional Techniques
Biliary stenosis not associated with a mass is difficult to diagnose with certainty. The diagnosis is usually based on a first-line cytological study of biliary brushing, which allows a diagnosis in 30 to 50% of cases. In the event of negativity, it is then possible to perform a cholangioscopy in a second step, which allows better sensitivity by performing biopsies. Performing cholangioscopy from the start could potentially save time and avoid disturbances associated with intermediate biliary stenting.
The main objective is to compare two strategies for exploring indeterminate biliary stenosis (1st vs. 2nd line retrograde cholangioscopy) in terms of diagnostic performance. The secondary objectives are to compare the same two strategies in terms of effectiveness, side effects and cost-effectiveness.
The primary outcome measure is the diagnostic yield (performance) of the initial investigation of indeterminate biliary stenosis: cytological brushing followed by cholangioscopy in case of failure (control group) or cholangioscopy from the start (study group).
調査の概要
状態
研究の種類
入学 (予想される)
段階
- 適用できない
連絡先と場所
研究連絡先
- 名前:Frederic Prat, MD, PhD
- 電話番号:+33 (0)140875663
- メール:frederic.prat@aphp.fr
研究連絡先のバックアップ
- 名前:Diane Lorenzo, MD
- メール:diane.lorenzo@aphp.fr
研究場所
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Clichy、フランス、92110
- 募集
- Hopital Beaujon
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コンタクト:
- frederic prat, MD, PhD
- 電話番号:+33 (0)140875663
- メール:maximilien.barret@aphp.fr
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参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
説明
Inclusion Criteria:
- Presence of intra- or extrahepatic biliary stenosis, involving the main bile ducts: common hepatic duct, right and left hepatic ducts
- Presence of clinical jaundice and / or biological cholestasis (GGT> 3N)
- Absence of visible mass near the biliary stenosis after initial morphological assessment by abdominal CT scan, MRI with biliary sequences.
- Endoscopic ultrasound performed and not having allowed the acquisition of material of diagnostic interest by guided puncture of the lesion.
- No history of ERCP in the 6 months preceding inclusion and no biliary prosthesis (plastic or metal) in place at the time of inclusion
- Collegial validation of the need for a formal diagnosis of indeterminate biliary stenosis in order to guide therapeutic management
- Patients aged 18 to 85
- Patient who gave his consent to participate in the study
- No contraindication to anesthesia (ASA 1, 2,3)
- Patient affiliated to a social security scheme (beneficiary or beneficiary)
- Absence of pregnancy and current contraception in women of childbearing age
Exclusion Criteria:
- Presence of a manifest tissue mass in relation to the biliary stenosis on CT and / or MRI imaging.
- Very strong presumption of the etiological diagnosis of biliary stenosis given the history (history, background): i.e. liver surgery, cholecystectomy, autoimmunity
- History of ERCP and / or percutaneous biliary drainage in the 6 months preceding inclusion
- Presence of a plastic or metal biliary prosthesis in place at the time of inclusion
- History of cephalic duodeno-pancreatectomy or hepatico-jejunal anastomosis
- Non-passable stenosis of the main bile duct
- Severe coagulopathy, thrombocytopenia <75,000 G / L, treatment with clopidogrel cannot be interrupted even temporarily
- Anesthetic contraindication (ASA 4)
- Inability to obtain informed consent
- person deprived of liberty
研究計画
研究はどのように設計されていますか?
デザインの詳細
- 主な目的:診断
- 割り当て:ランダム化
- 介入モデル:並列代入
- マスキング:なし(オープンラベル)
武器と介入
参加者グループ / アーム |
介入・治療 |
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アクティブコンパレータ:cytological brushing followed by cholangioscopy in case of failure
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手順:endoscopic retrograde cholangiopancreatography with cholangioscopy in the first procedure of ERCP
endoscopic retrograde cholangiopancreatography with cholangioscopy in the first procedure for exploration of an indeterminate biliary stenosis and biliary drainage
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実験的:cholangioscopy from the start
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手順:endoscopic retrograde cholangiopancreatography with cholangioscopy in the first procedure of ERCP
endoscopic retrograde cholangiopancreatography with cholangioscopy in the first procedure for exploration of an indeterminate biliary stenosis and biliary drainage
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この研究は何を測定していますか?
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
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Diagnostic yield (performance) of the initial investigation of indeterminate biliary stenosis: cytological brushing followed by cholangioscopy in case of failure (control group) or cholangioscopy from the start (study group).
時間枠:48 months
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Diagnostic performance is expressed primarily by sensitivity for the diagnosis of malignancy.
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48 months
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二次結果の測定
結果測定 |
時間枠 |
---|---|
Specific rate of diagnosis with cholangioscopy by spyglass used in 1st or 2nd intention
時間枠:48 months
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48 months
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Rate of adverse events related to diagnostic procedures in each of the 2 groups
時間枠:48 months
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48 months
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Comparison of the costs of the 2 diagnostic strategies
時間枠:48 months
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48 months
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協力者と研究者
スポンサー
研究記録日
主要日程の研究
研究開始 (実際)
一次修了 (実際)
研究の完了 (予想される)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (実際)
学習記録の更新
投稿された最後の更新 (実際)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
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