Amy Tyberg1, Isaac Raijman2, Ali Siddiqui3, Urban Arnelo4, Douglas G Adler5, Ming-Ming Xu1, Najib Nassani6, Divyesh V Sejpal7, Prashant Kedia8, Yun Nah Lee9, Frank G Gress10, Sammy Ho11, Monica Gaidhane1, Michel Kahaleh1. 1. Weill Cornell Medical Center. 2. Department of Gastroenterology, Houston Medical Center, Houston. 3. Department of Gastroenterology, Thomas Jefferson University, Philadelphia, PA. 4. Department of Gastroenterology, Karolinska Institut, Stockholm, Sweden. 5. Department of Gastroenterology, University of Utah, Salt Lake City, UT. 6. Department of Gastroenterology, Staten Island University Hospital, Staten Island. 7. Department of Gastroenterology, North Shore LIJ, Long Island. 8. Department of Gastroenterology, Methodist, Dallas, TX. 9. Department of Gastroenterology, SoonChunHyang University School of Medicine, Seoul, Republic of Korea. 10. Department of Gastroenterology, CUMC, New York. 11. Department of Gastroenterology, Montefiore Medical Center, Bronx, NY.
Abstract
INTRODUCTION: In patients with pancreaticobiliary lesions anticipating surgical resection, digital pancreaticocholangioscopy can be used to identify the extent of disease. This presurgical"mapping" could change the surgical plan and optimize patient care. MATERIALS AND METHODS: Patients with pancreaticobiliary lesions anticipating surgery who underwent endoscopic retrograde cholangiopancreatography with digital pancreaticocholangioscopy from 9 international centers were included. Primary outcome was whether pancreaticocholangioscopy altered the surgical plan. Secondary outcome was correlation between surgical and endoscopic histology and adverse events. RESULTS: A total of 118 patients were included (64% male, mean age 69 y): cholangioscopy in 105 patients (89%), pancreatoscopy in 13 patients (11%). Pancreaticocholangioscopy changed the surgical plan in 39 (34%) of patients: 8 of 13 in the pancreatic duct, 32 of 105 in the bile duct. In the bile duct, 6 patients (5%) had less extensive surgery, 26 patients (25%) avoided surgery. In the pancreatic duct, 4 patients (31%) had more extensive surgery and 4 patients (31%) had less extensive surgery. Four patients with downstaged surgery had positive margins on surgical resection; 1 required additional surgical intervention. Overall correlation between endoscopy and surgical histology was 88%. Adverse events included post endoscopic retrograde cholangiopancreatography pancreatitis in 3 patients (2.5%). CONCLUSION: Digital pancreaticocholangioscopy can be effectively used as a mapping tool to delineate the degree of involvement of biliary lesions before surgical resection, in some cases altering the surgical plan. Prospective studies are needed, especially when downstaging surgery.
INTRODUCTION: In patients with pancreaticobiliary lesions anticipating surgical resection, digital pancreaticocholangioscopy can be used to identify the extent of disease. This presurgical"mapping" could change the surgical plan and optimize patient care. MATERIALS AND METHODS:Patients with pancreaticobiliary lesions anticipating surgery who underwent endoscopic retrograde cholangiopancreatography with digital pancreaticocholangioscopy from 9 international centers were included. Primary outcome was whether pancreaticocholangioscopy altered the surgical plan. Secondary outcome was correlation between surgical and endoscopic histology and adverse events. RESULTS: A total of 118 patients were included (64% male, mean age 69 y): cholangioscopy in 105 patients (89%), pancreatoscopy in 13 patients (11%). Pancreaticocholangioscopy changed the surgical plan in 39 (34%) of patients: 8 of 13 in the pancreatic duct, 32 of 105 in the bile duct. In the bile duct, 6 patients (5%) had less extensive surgery, 26 patients (25%) avoided surgery. In the pancreatic duct, 4 patients (31%) had more extensive surgery and 4 patients (31%) had less extensive surgery. Four patients with downstaged surgery had positive margins on surgical resection; 1 required additional surgical intervention. Overall correlation between endoscopy and surgical histology was 88%. Adverse events included post endoscopic retrograde cholangiopancreatography pancreatitis in 3 patients (2.5%). CONCLUSION: Digital pancreaticocholangioscopy can be effectively used as a mapping tool to delineate the degree of involvement of biliary lesions before surgical resection, in some cases altering the surgical plan. Prospective studies are needed, especially when downstaging surgery.
Authors: Alex B Blair; Ross M Beckman; Joseph R Habib; James F Griffin; Kelly Lafaro; Richard A Burkhart; William Burns; Matthew J Weiss; John L Cameron; Christopher L Wolfgang; Jin He Journal: HPB (Oxford) Date: 2021-09-23 Impact factor: 3.842
Authors: Y H Andrew Wu; Atsushi Oba; Laurel Beaty; Kathryn L Colborn; Salvador Rodriguez Franco; Ben Harnke; Cheryl Meguid; Daniel Negrini; Roberto Valente; Steven Ahrendt; Richard D Schulick; Marco Del Chiaro Journal: Cancers (Basel) Date: 2021-04-22 Impact factor: 6.639
Authors: Carlos Robles-Medranda; Miguel Soria-Alcívar; Roberto Oleas; Jorge Baquerizo-Burgos; Miguel Puga-Tejada; Manuel Valero; Hannah Pitanga-Lukashok Journal: Endosc Int Open Date: 2020-05-25