Trial Information

A Pilot Study of Confocal Endomicroscopy for Biliary Strictures - Phase I

Despite recent advances in biliary imaging and biliary tissue acquisition, the diagnosis and
tissue-confirmation in suspected malignant biliary obstruction remains challenging. Patients
often undergo repeat endoscopic and cross sectional imaging procedures, and even surgical
exploration to establish a diagnosis. A major new advancement in cancer imaging is the
development of a probe-based confocal endomicroscopy (pCLE) system capable of cellular and
sub-cellular imaging of the biliary tree. Preliminary data suggests that pCLE can accurately
detect or exclude malignancy within otherwise indeterminate strictures. In this study, we
propose to validate these preliminary findings and compare two methods of pCLE image
acquisition that are important for clinical translation of the technology.

This is a Phase 1 Study: During this study, in vivo microscopic images of 10 benign
(post-operative from know benign disease such as orthotopic liver transplant) and 10
malignant (cytology-positive) strictures will be obtained at ERCP. Patients clinical course
will be followed and a composite gold standard will be used for comparison to pCLE. These
confocal images of biliary lesions will be reviewed side by side, unblinded to the reference
standard by the endoscopists. The basic image characteristics allowing distinction between
benign and malignant tissue will be established (details of features noted and examined are
below). We will also assess whether good quality images can be feasibly obtained without the
cholangioscopic guidance.