{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T23:05:12Z","timestamp":1782947112537,"version":"3.54.5"},"reference-count":27,"publisher":"Georg Thieme Verlag KG","issue":"11","license":[{"start":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T00:00:00Z","timestamp":1747958400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endoscopy"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:p>Background\u2002Digital single-operator cholangioscopy (dSOC) has improved the diagnostic accuracy of indeterminate biliary duct strictures (IBDS) through targeted intraductal biopsy sampling. However, the optimal biopsy technique remains uncertain.<\/jats:p>\n                  <jats:p>Methods\u2002This international, multicenter, prospective interventional study (November 2020\u2013August 2022) included patients with IBDS undergoing dSOC. Stricture sampling involved obtaining at least four single biopsies and at least one bite-on-bite biopsy (BBB) in all patients. Definitive diagnosis was established by pathology outcomes and 1-year clinical follow-up. The primary outcome was the accuracy of both biopsy techniques.<\/jats:p>\n                  <jats:p>Results\u200289 patients were included, with 76 hilar strictures and 13 distal strictures. Technical success for obtaining adequate tissue samples was 82\/89 (92.1\u200a%) for single biopsies and 78\/89 (87.6\u200a%) for BBB. Malignancy was confirmed in 31\/82 (37.8\u200a%) and 29\/78 (37.2\u200a%) cases in single biopsies and BBB, respectively. Among 76 patients in whom both techniques were successful, pathology results were discordant in three cases (3.9\u200a%), primarily due to understaging by BBB. Among 82 patients with complete follow-up, malignancy was confirmed in 51 (62.2\u200a%). Sensitivity, specificity, and accuracy for malignancy or high grade dysplasia were 66.0\u200a%, 100\u200a%, and 78.8\u200a% for single biopsies, and 63.8\u200a%, 100\u200a%, and 77.6\u200a% for BBB, respectively. Sensitivity and accuracy were significantly decreased after stent placement or intraductal tissue acquisition during prior ERCP. The number of BBBs did not impact sensitivity or accuracy.<\/jats:p>\n                  <jats:p>Conclusions\u2002BBB did not outperform at least four single biopsies for IBDS. Prior manipulation of IBDS, through stent placement or prior tissue acquisition, was associated with a decreased diagnostic yield.<\/jats:p>","DOI":"10.1055\/a-2619-6803","type":"journal-article","created":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T18:45:17Z","timestamp":1748025917000},"page":"1220-1229","source":"Crossref","is-referenced-by-count":7,"title":["The value of cholangioscopy-guided bite-on-bite (-on bite) biopsies in indeterminate biliary duct strictures"],"prefix":"10.1055","volume":"57","clinical-trial-number":[{"clinical-trial-number":"nl9649","registry":"10.18810\/dutch-trial-register"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5068-8227","authenticated-orcid":false,"given":"David M.","family":"de Jong","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pieter Jan F.","family":"de Jonge","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6887-9064","authenticated-orcid":false,"given":"Pauline M. C.","family":"Stassen","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2297-547X","authenticated-orcid":false,"given":"Petko","family":"Karagyozov","sequence":"additional","affiliation":[{"name":"Clinic of Gastroenterology, Acibadem City Clinic University Hospital Tokuda, Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1446-3121","authenticated-orcid":false,"given":"Juan J.","family":"Vila","sequence":"additional","affiliation":[{"name":"Endoscopy Unit, Gastroenterology Department, Hospital Universitario de Navarra, IdiSNA, Navarra Institute for Health Research, Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1741-6868","authenticated-orcid":false,"given":"Ignacio","family":"Fern\u00e1ndez-Uri\u00e9n","sequence":"additional","affiliation":[{"name":"Endoscopy Unit, Gastroenterology Department, Hospital Universitario de Navarra, IdiSNA, Navarra Institute for Health Research, Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin W.","family":"James","sequence":"additional","affiliation":[{"name":"NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, and School of Medicine, University of Nottingham, Nottingham, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5576-310X","authenticated-orcid":false,"given":"Suresh V.","family":"Venkatachalapathy","sequence":"additional","affiliation":[{"name":"NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, and School of Medicine, University of Nottingham, Nottingham, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7381-7412","authenticated-orcid":false,"given":"Kofi W.","family":"Oppong","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1021-0031","authenticated-orcid":false,"given":"Andrea","family":"Anderloni","sequence":"additional","affiliation":[{"name":"Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1621-6450","authenticated-orcid":false,"given":"Alessandro","family":"Repici","sequence":"additional","affiliation":[{"name":"Endoscopy 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