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Kiritani S, Kawaguchi Y, Nishioka Y, Mihara Y, Ichida A, Takamoto T, Akamatsu N, Hasegawa K. Long-term outcomes of hepatopancreatoduodenectomy for perihilar cholangiocarcinoma: A comparative study with conventional hepatectomy. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2025; 51:109633. [PMID: 39892087 DOI: 10.1016/j.ejso.2025.109633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2024] [Revised: 01/09/2025] [Accepted: 01/22/2025] [Indexed: 02/03/2025]
Abstract
INTRODUCTION Hepatopancreatoduodenectomy (HPD) is necessary to achieve a reliable margin-negative resection for widespread perihilar cholangiocarcinoma (PhCC), yet data on long-term outcomes following HPD for PhCC remain limited. MATERIALS AND METHODS A retrospective cohort study was conducted on 167 patients with PhCC who underwent surgery with curative-intent between 2000 and 2023. Hepatic resection and extrahepatic bile duct resection (Hr-BDR) were performed for cases presumed to have localized tumors, while HPD was conducted for cases with presumed extensive tumor spread. Short- and long-term outcomes, including surgery details, pathological findings, postoperative complications, survival rates, and recurrence patterns, were compared. RESULTS Forty-five patients underwent HPD and 122 underwent Hr-BDR. No differences were observed in the T or N factors of the TNM staging between both groups (P = 0.09 and 0.09). Overall postoperative significant complications (38 % vs. 34 %, P = 0.62), 90-day mortality rates (2 % vs. 2 %, P = 0.80), and 5-year cancer-specific survival (45 % vs. 40 %, P = 0.81) were comparable between both groups. However, the 5-year survival rate of the HPD group was significantly higher than that of the Hr-BDR group with positive invasive duodenal-side ductal margins (45 % vs. 0 %, P = 0.03). Local and remnant bile duct recurrence were significantly less frequent in the HPD than in the Hr-BDR group (20 % vs. 37 %, P = 0.04; 11 % vs. 0 %, P = 0.02, respectively). CONCLUSION Although HPD for widespread PhCC requires careful postoperative management, it has the potential to provide excellent long-term outcomes, and it should be considered proactively.
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Affiliation(s)
- Sho Kiritani
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshikuni Kawaguchi
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yujiro Nishioka
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuichiro Mihara
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akihiko Ichida
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takeshi Takamoto
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nobuhisa Akamatsu
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kiyoshi Hasegawa
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
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Aoyagi Y, Gaudenzi F, Wakabayashi T, Teshigahara Y, Nie Y, Wakabayashi G. Robotic surgery for perihilar cholangiocarcinoma: a concise systematic review. Surg Endosc 2025; 39:2701-2710. [PMID: 40085228 DOI: 10.1007/s00464-025-11650-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2024] [Accepted: 03/02/2025] [Indexed: 03/16/2025]
Abstract
BACKGROUND Perihilar cholangiocarcinoma (PHC) is a challenging malignancy with a poor prognosis, and the role of robotic surgery in its management remains debated. This systematic review aims to assess the feasibility of robotic surgery for PHC. METHODS A systematic literature search was conducted following PRISMA guidelines in Medline, Cochrane Library, and Web of Science for English-language studies on robotic surgery for PHC between 2000 and 2024. RESULTS Of the initial 405 manuscripts identified, five studies comprising 110 patients met the inclusion criteria. Pooled analysis showed that operative time ranged from 276 (170-500) to 840 (770-890) minutes, with intraoperative blood loss between 125 (50-425) and 700 (600-800) ml. The rates of overall and major morbidity were 50.0% and 13.6%, respectively. The 30-day and 90-day postoperative mortality rates were 1.8% and 1.9%, respectively. R0 resections were achieved in 78.2% of patients, with a median lymph node retrieval of 7 (8 ± 6.6) to 11 (6-31). Follow-up duration ranged from 7.5 (8.3 ± 2.3) to 15 (19 ± 16) months, recurrence was observed in 14.3% (6/42) of patients. CONCLUSIONS Robotic surgery for PHC demonstrates promising perioperative outcomes; however, further studies are needed to assess its long-term oncological efficacy compared with traditional approaches.
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Affiliation(s)
- Yutaro Aoyagi
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, 1-10-10 Kashiwaza, Ageo City, Saitama, 362-8588, Japan
| | - Federico Gaudenzi
- Hepato-Pancreato-Biliary and Transplant Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60126, Ancona, Italy
| | - Taiga Wakabayashi
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, 1-10-10 Kashiwaza, Ageo City, Saitama, 362-8588, Japan.
| | - Yu Teshigahara
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, 1-10-10 Kashiwaza, Ageo City, Saitama, 362-8588, Japan
| | - Yusuke Nie
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, 1-10-10 Kashiwaza, Ageo City, Saitama, 362-8588, Japan
| | - Go Wakabayashi
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, 1-10-10 Kashiwaza, Ageo City, Saitama, 362-8588, Japan
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Ozono Y, Kawakami H, Uchiyama N, Hatada H, Ogawa S. Current status and issues in genomic analysis using EUS-FNA/FNB specimens in hepatobiliary-pancreatic cancers. J Gastroenterol 2023; 58:1081-1093. [PMID: 37698719 PMCID: PMC10590314 DOI: 10.1007/s00535-023-02037-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 08/28/2023] [Indexed: 09/13/2023]
Abstract
Comprehensive genomic profiling based on next-generation sequencing has recently been used to provide precision medicine for various advanced cancers. Endoscopic ultrasound (EUS)-guided fine-needle aspiration (EUS-FNA) and EUS-guided fine-needle biopsy (EUS-FNB) play essential roles in the diagnosis of abdominal masses, mainly pancreatic cancers. In recent years, CGP analysis using EUS-FNA/FNB specimens for hepatobiliary-pancreatic cancers has increased; however, the success rate of CGP analysis is not clinically satisfactory, and many issues need to be resolved to improve the success rate of CGP analysis. In this article, we review the transition from EUS-FNA to FNB, compare each test, and discuss the current status and issues in genomic analysis of hepatobiliary-pancreatic cancers using EUS-FNA/FNB specimens.
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Affiliation(s)
- Yoshinori Ozono
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Hiroshi Kawakami
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan.
| | - Naomi Uchiyama
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Hiroshi Hatada
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Souichiro Ogawa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
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Hayashi H, Shimizu A, Kubota K, Notake T, Masuo H, Yoshizawa T, Hosoda K, Sakai H, Yasukawa K, Soejima Y. Accuracy and limitations of preoperative assessment of longitudinal spread of perihilar cholangiocarcinoma. Asian J Surg 2023; 46:4743-4748. [PMID: 37085419 DOI: 10.1016/j.asjsur.2023.03.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/22/2023] [Accepted: 03/30/2023] [Indexed: 04/23/2023] Open
Abstract
OBJECTIVE Although surgical resection offers the only chance of cure of perihilar cholangiocarcinoma and R1 resection has a poor prognosis, there is no consensus on optimal preoperative assessment of its longitudinal spread. We aimed to establish the optimal means of achieving this goal. METHODS This was a retrospective, single-center study of 61 patients who had undergone multi-detector row computed tomography, endoscopic retrograde cholangiography, intraductal ultrasonography, and mapping biopsy prior to resection of perihilar cholangiocarcinomas in our institute from January 2010 and December 2021. RESULTS The most accurate single methods for assessing longitudinal spread were intraductal ultrasonography and mapping biopsy (both 72.1%). A combination of all four assessment methods was accurate in 51 (83.6%) of our patients. Independent risk factors for inaccuracy were Bismuth-Corlette Type IV and high histologic-grade tumors. The R0 resection rate was higher with accurate than inaccurate assessments (90.2% vs. 30.0%, P < 0.001). R0 resection was associated with significantly better relapse-free survival than R1 resection (P = 0.006). However, overall survival did not differ between these groups. CONCLUSION Preoperative assessment of longitudinal spread of perihilar cholangiocarcinomas by four different modalities is optimal, achieving 83.6% accuracy and a 90.2% R0 resection rate.
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Affiliation(s)
- Hikaru Hayashi
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Japan
| | - Akira Shimizu
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Japan.
| | - Koji Kubota
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Japan
| | - Tsuyoshi Notake
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Japan
| | - Hitoshi Masuo
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Japan
| | - Takahiro Yoshizawa
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Japan
| | - Kiyotaka Hosoda
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Japan
| | - Hiroki Sakai
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Japan
| | - Koya Yasukawa
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Japan
| | - Yuji Soejima
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Japan
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Koiwai A, Hirota M, Murakami K, Katayama T, Kin R, Endo K, Kogure T, Takasu A, Sakurai H, Kondo N, Takami K, Yamamoto K, Katayose Y, Satoh K. Direct peroral cholangioscopy with red dichromatic imaging 3 detected the perihilar margin of superficial papillary extension in a patient with intraductal papillary neoplasm of the bile duct. DEN OPEN 2023; 3:e228. [PMID: 36998349 PMCID: PMC10043355 DOI: 10.1002/deo2.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/24/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023]
Abstract
Intraductal papillary neoplasms of the bile duct (IPNB) are a tumor derived from bile duct epithelium that tends to spread laterally and non‐invasively. Surgery is the first‐choice treatment for IPNB. It is extremely important to accurately diagnose the extent of lateral tumor extension. Although peroral cholangioscopy (POCS) is a potentially useful modality for detecting tumor range with direct observation, poor image quality is a limitation of POCS. Recently, a new‐generation endoscopy system (EVIS X1) was equipped with functions such as red dichromatic imaging to improve image quality. A 75‐year‐old man with cholangitis was referred to our department. Various imaging studies showed a mass in the middle to lower bile duct and dilatation of the common bile duct and the intrahepatic bile duct. Endoscopic retrograde cholangiopancreatography was performed. A biopsy of the main tumor in the lower common bile duct revealed IPNB. It was difficult to determine the extent of superficial tumor extension with modalities such as contrast‐enhanced computed tomography, magnetic resonance imaging, and endoscopic ultrasonography but the detailed evaluation was possible using POCS with red dichromatic imaging 3. The patient underwent hepatopancreatoduodenectomy. This case suggests the usefulness of direct observation using POCS with red dichromatic imaging 3 to determine the range of IPNB.
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Affiliation(s)
- Akinobu Koiwai
- Division of GastroenterologyTohoku Medical and Pharmaceutical UniversityMiyagiJapan
| | - Morihisa Hirota
- Division of GastroenterologyTohoku Medical and Pharmaceutical UniversityMiyagiJapan
| | - Keigo Murakami
- Division of PathologyTohoku Medical and Pharmaceutical UniversityMiyagiJapan
- Department of Investigative PathologyTohoku University Graduate School of MedicineMiyagiJapan
| | - Tomofumi Katayama
- Division of GastroenterologyTohoku Medical and Pharmaceutical UniversityMiyagiJapan
| | - Ryo Kin
- Division of GastroenterologyTohoku Medical and Pharmaceutical UniversityMiyagiJapan
| | - Katsuya Endo
- Division of GastroenterologyTohoku Medical and Pharmaceutical UniversityMiyagiJapan
| | - Takayuki Kogure
- Division of GastroenterologyTohoku Medical and Pharmaceutical UniversityMiyagiJapan
| | - Atsuko Takasu
- Division of GastroenterologyTohoku Medical and Pharmaceutical UniversityMiyagiJapan
| | - Hiroto Sakurai
- Division of Hepato‐biliary and Pancreatic SurgeryTohoku Medical and Pharmaceutical UniversityMiyagiJapan
| | - Noriko Kondo
- Division of Hepato‐biliary and Pancreatic SurgeryTohoku Medical and Pharmaceutical UniversityMiyagiJapan
| | - Kazuhiro Takami
- Division of Hepato‐biliary and Pancreatic SurgeryTohoku Medical and Pharmaceutical UniversityMiyagiJapan
| | - Kuniharu Yamamoto
- Division of Hepato‐biliary and Pancreatic SurgeryTohoku Medical and Pharmaceutical UniversityMiyagiJapan
| | - Yu Katayose
- Division of Hepato‐biliary and Pancreatic SurgeryTohoku Medical and Pharmaceutical UniversityMiyagiJapan
| | - Kennichi Satoh
- Division of GastroenterologyTohoku Medical and Pharmaceutical UniversityMiyagiJapan
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Cadamuro M, Al-Taee A, Gonda TA. Advanced endoscopy meets molecular diagnosis of cholangiocarcinoma. J Hepatol 2023; 78:1063-1072. [PMID: 36740048 DOI: 10.1016/j.jhep.2023.01.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/22/2022] [Accepted: 01/18/2023] [Indexed: 02/07/2023]
Abstract
Cholangiocarcinoma remains an aggressive and deadly malignancy that is often diagnosed late. Intrinsic tumour characteristics and the growth pattern of cancer cells contribute to the challenges of diagnosis and chemoresistance. However, establishing an early and accurate diagnosis, and in some instances identifying targetable changes, has the potential to impact survival. Primary sclerosing cholangitis, a chronic cholangiopathy prodromal to the development of a minority of cholangiocarcinomas, poses a particular diagnostic challenge. We present our diagnostic and theranostic approach to the initial evaluation of cholangiocarcinomas, focusing on extrahepatic cholangiocarcinoma. This involves a multipronged strategy incorporating advanced imaging, endoscopic methods, multiple approaches to tissue sampling, and molecular markers. We also provide an algorithm for the sequential use of these tools.
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Affiliation(s)
| | - Ahmad Al-Taee
- Carle Illinois College of Medicine, University of Illinois Urbaba-Champaign, Champaign County, IL, USA
| | - Tamas A Gonda
- Division of Gastroenterology and Hepatology, New York University, New York, NY, USA.
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Diagnosis of Cholangiocarcinoma. Diagnostics (Basel) 2023; 13:diagnostics13020233. [PMID: 36673043 PMCID: PMC9858255 DOI: 10.3390/diagnostics13020233] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
Cholangiocarcinoma (CCA), a tumor of the bile duct epithelium, is increasing in incidence. CCA remains a highly fatal malignancy because early diagnosis is difficult. Based on its anatomical location, CCA can be categorized into the following three groups: perihilar, intrahepatic, and extrahepatic. Patients with CCA complain of asymptomatic jaundice, weight loss, and right upper quadrant abdominal discomfort. Imaging modalities, including transabdominal ultrasound, computed tomography, and magnetic resonance imaging, play an important role in detecting tumors as well as guiding biopsy procedures and staging workups in CCA. Characteristically, extrahepatic CCA shows abrupt changes in ductal diameter with upstream ductal dilation. Endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) are recommended as the next step in the evaluation of extrahepatic CCA. Tissue is obtained through EUS-FNA or ERCP (biopsy, brush cytology), and therapeutic intervention (such as stent insertion) is performed with ERCP. Moreover, several serum tumor markers (carbohydrate antigen 19-9 and carcinoembryonic antigen) can be useful in diagnosing CCA in some patients.
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Matsuzawa H, Goto T, Shibuya T, Sato W, Chiba M, Takahashi K, Minami S, Sato Y, Iijima K. A Preoperative Diagnosis of Advanced Cystic Duct Carcinoma Using SpyGlass DS Cholangioscopy: A Report of Two Cases. Intern Med 2022. [PMID: 36261386 DOI: 10.2169/internalmedicine.9732-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
Primary cystic duct carcinoma is a rare tumor. The curative treatment of cystic duct carcinoma is complete surgical resection, for which the evaluation of local extension is important. We herein report two cases of cystic duct carcinoma in which a preoperative examination was performed using per-oral cholangioscopy (POCS). Both patients underwent POCS due to suspicion of cystic duct carcinoma based on imaging findings. A visual analysis and biopsy were performed to evaluate local extension, which led to surgery. These cases suggest that POCS is useful for the preoperative assessment of local extension in advanced cystic duct carcinoma.
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Affiliation(s)
- Hisanori Matsuzawa
- Department of Gastroenterology, Graduate School of Medicine, Akita University, Japan
| | - Takashi Goto
- Department of Gastroenterology, Graduate School of Medicine, Akita University, Japan
| | - Tomomi Shibuya
- Department of Gastroenterology, Graduate School of Medicine, Akita University, Japan
| | - Wataru Sato
- Department of Gastroenterology, Graduate School of Medicine, Akita University, Japan
| | - Mitsuru Chiba
- Department of Gastroenterology, Graduate School of Medicine, Akita University, Japan
| | - Kenichi Takahashi
- Department of Gastroenterology, Graduate School of Medicine, Akita University, Japan
| | - Shinichiro Minami
- Department of Gastroenterology, Graduate School of Medicine, Akita University, Japan
| | - Yuki Sato
- Department of Gastroenterology, Graduate School of Medicine, Akita University, Japan
| | - Katsunori Iijima
- Department of Gastroenterology, Graduate School of Medicine, Akita University, Japan
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Tsuyuguchi T. Pancreato-hepatobiliary endoscopy: Cholangioscopy. Dig Endosc 2022; 34 Suppl 2:107-110. [PMID: 34590352 DOI: 10.1111/den.14138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Toshio Tsuyuguchi
- Department of Gastroenterology, Chiba Prefectural Sawara Hospital, Chiba, Japan
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10
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Fukuhara S, Iwasaki E, Kayashima A, Machida Y, Tamagawa H, Kawasaki S, Horibe M, Hori S, Abe Y, Kitago M, Ogata H, Kanai T. Endoscopic Diagnosis of Biliary Stricture Combined with Digital Cholangioscope: A Case Series. Healthcare (Basel) 2021; 10:healthcare10010012. [PMID: 35052176 PMCID: PMC8775675 DOI: 10.3390/healthcare10010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/18/2021] [Accepted: 12/20/2021] [Indexed: 11/18/2022] Open
Abstract
The endoscopic diagnosis of biliary tract lesions is applied as a non-invasive method; however, its diagnostic accuracy is not yet high. Moreover, digital cholangioscopy is used for directly visualizing the inside of the bile duct, resulting in a more precise biopsy. We present the case series of the outcomes of diagnosis using digital cholangioscopy in patients who underwent cholangioscopy for the evaluation of biliary stenosis in our department between January 2014 and March 2021. The controls were those who underwent a biopsy for biliary stenosis with conventional endoscopic retrograde cholangiopancreatography (ERCP). Background data for each case were collected, and the clinical outcomes by biopsy were evaluated, focusing on the accuracy of the diagnosis. Cholangioscopy was performed in 15 cases, while a conventional biopsy by ERCP was performed in 172 cases. Nine of 15 cases (60.0%) were diagnosed with cholangiocarcinoma. The number of specimens obtained through conventional ERCP and cholangioscopy was 2.5 ± 1.3 and 3.3 ± 1.5, respectively (p = 0.043). The diagnostic accuracy of conventional ERCP and cholangioscopy were 65.7% (113 of 172 cases) and 100%, respectively, which was significantly higher in the group with cholangioscopy. Digital cholangioscopy is useful when the diagnosis of the biliary stricture using the conventional ERCP method is difficult.
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Affiliation(s)
- Seiichiro Fukuhara
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo 160-8582, Japan; (S.F.); (H.O.)
- National Hospital Organization Tokyo Medical Center, Division of Gastroenterology and Hepatology, Tokyo 152-8902, Japan;
| | - Eisuke Iwasaki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan; (A.K.); (Y.M.); (S.K.); (M.H.); (T.K.)
- Correspondence: ; Tel.: +81-3-5363-3790
| | - Atsuto Kayashima
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan; (A.K.); (Y.M.); (S.K.); (M.H.); (T.K.)
| | - Yujiro Machida
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan; (A.K.); (Y.M.); (S.K.); (M.H.); (T.K.)
| | - Hiroki Tamagawa
- National Hospital Organization Tokyo Medical Center, Division of Gastroenterology and Hepatology, Tokyo 152-8902, Japan;
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan; (A.K.); (Y.M.); (S.K.); (M.H.); (T.K.)
| | - Shintaro Kawasaki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan; (A.K.); (Y.M.); (S.K.); (M.H.); (T.K.)
| | - Masayasu Horibe
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan; (A.K.); (Y.M.); (S.K.); (M.H.); (T.K.)
| | - Shutaro Hori
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan; (S.H.); (Y.A.); (M.K.)
| | - Yuta Abe
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan; (S.H.); (Y.A.); (M.K.)
| | - Minoru Kitago
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan; (S.H.); (Y.A.); (M.K.)
| | - Haruhiko Ogata
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo 160-8582, Japan; (S.F.); (H.O.)
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan; (A.K.); (Y.M.); (S.K.); (M.H.); (T.K.)
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11
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Impact of preoperative biliary drainage on postoperative outcomes in hilar cholangiocarcinoma. Asian J Surg 2021; 45:993-1000. [PMID: 34588138 DOI: 10.1016/j.asjsur.2021.07.075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/19/2021] [Accepted: 07/21/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND/OBJECTIVE Complete resection is the most effective treatment of hilar cholangiocarcinoma (HC) but may result in high morbidity and mortality. Most HC patients have jaundice, and preoperative biliary drainage may reduce their risk of obstructive jaundice. ERCP and PTBD have been advocated for this purpose. This retrospective study investigated the influence of ERCP versus PTBD versus their combination on the short-term outcomes of curative HC resection. METHODS Patients having curative HC resection with preoperative biliary drainage in a span of 26 years were reviewed and divided into groups according to drainage modality. Drainage-related and surgical complications and hospital mortality were compared between groups. Intention-to-treat analysis using a separate set of initial drainage data was performed. RESULTS Eighty-six patients were divided into: Group A, ERCP only, n = 32 (32/86 = 37.2%); Group B, PTBD only, n = 10 (10/86 = 11.6%); Group C, ERCP + PTBD, n = 44 (44/86 = 51.2%). International normalized ratio was significantly higher in Group B (p = 0.008). The three groups were comparable in operative details, hospital stay, and mortality. Fifty-two patients had postoperative complications. Significantly more patients in Groups A and C had subphrenic abscess (A: 25%, B: 0%, C: 9.1%; p = 0.035) and subsequent radiological drainage. Group A had insignificantly more patients with wound infection (31.3% vs 10% vs 22.7%, p = 0.334), chest infection (28.1% vs 20% vs 11.4%, p = 0.178), and urinary tract infection (6.3% vs 0% vs 0%, p = 0.133). The three groups had similar rates of major complications (p = 0.501). They also had comparable survival outcomes (overall, p = 0.370; disease-free, p = 0.569). Fifteen and 71 patients received PTBD and ERCP respectively as first drainage mode. These two groups were comparable in liver function, preoperative comorbidity, intraoperative details, and postoperative outcomes. CONCLUSION In the preoperative management of HC, the use of ERCP, PTBD or their combination is acceptable and can optimize patients' condition for curative HC resection.
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Diagnostic value of peroral cholangioscopy in addition to computed tomography for indeterminate biliary strictures. Surg Endosc 2021; 36:3408-3417. [PMID: 34370123 DOI: 10.1007/s00464-021-08661-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Peroral cholangioscopy (POCS) has been used to overcome the difficulty in diagnosing indeterminate biliary stricture or tumor spread. However, the value of adding POCS to computed tomography (CT) remains unclear. Our aim was to evaluate the diagnostic value of adding POCS to CT for indeterminate biliary stricture and tumor spread by interpretation of images focusing on the high diagnostic accuracy of visual findings in POCS. METHODS We retrospectively identified 52 patients with biliary stricture who underwent endoscopic retrograde cholangiography (ERC) at our institution between January 2013 and December 2018. Two teams, each composed of an expert endoscopist and surgeon, performed the interpretation independently, referring to the CT findings of the radiologist. The CT + ERC + POCS images (POCS group) were evaluated 4 weeks after the evaluation of CT + ERC images (CT group). A 5-point scale (1: definitely benign to 5: definitely malignant) was used to determine the confident diagnosis rate, which was defined as an evaluation value of 1 or 5. Tumor spread was also evaluated. RESULTS In the evaluation of 45 malignant diagnoses, the score was significantly closer to 5 in the POCS group than in the CT group in both teams (P < 0.001). The confident diagnosis rate was significantly higher for the POCS group (92% and 73%) than for the CT group (25% and 12%) in teams 1 and 2, respectively (P < 0.001). We found no significant difference in diagnostic accuracy for tumor spread between the groups. CONCLUSION Visual POCS findings confirmed the diagnosis of biliary strictures. POCS was useful in cases of indefinite diagnosis of biliary strictures by CT.
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Hao J, Huang X. The Status and Development of Oral Choledochoscopy Diagnosis and Treatment of Biliary Tract Diseases. Int J Gen Med 2021; 14:4269-4277. [PMID: 34393506 PMCID: PMC8360357 DOI: 10.2147/ijgm.s317484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 07/14/2021] [Indexed: 12/12/2022] Open
Abstract
Choledochoscopy technology has realized the direct observation of bile duct lesions, and can be loaded with a variety of special accessories to perform the corresponding diagnosis and treatment operations, and has become an important means for the diagnosis of unexplained bile duct stricture and treatment of refractory bile duct stones. With the further enhancement of the imaging quality and operability, the clinical application of choledochoscopy has gradually expanded to the precise positioning of cholangiocarcinoma before surgical resection, the drainage of the gallbladder through the nipple, the removal of the displaced bile duct stent and other fields. This paper briefly reviewed the historical evolution of choledochoscopy and reviewed the latest clinical advances of oral choledochoscopy in the diagnosis and treatment of biliary tract diseases.
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Affiliation(s)
- Jinyong Hao
- Department of Gastroenterology, Lanzhou University Second Hospital, Lanzhou, People's Republic of China.,Gansu Provincial Digestive Endoscopy Engineering Research Center, Lanzhou, People's Republic of China
| | - Xiaojun Huang
- Department of Gastroenterology, Lanzhou University Second Hospital, Lanzhou, People's Republic of China.,Gansu Provincial Digestive Endoscopy Engineering Research Center, Lanzhou, People's Republic of China
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Abstract
BACKGROUND : Accurate preoperative assessment of the longitudinal extension of perihilar cholangiocarcinoma (PHCC) is essential for treatment planning. Mapping biopsies for PHCC remain challenging owing to technical difficulties and insufficient sample amounts. The aim of this study was to investigate the usefulness of a novel technique for mapping biopsies of PHCC. METHODS : Our novel method focused on a biliary stent delivery system for mapping biopsies. Fifty patients with PHCC undergoing endoscopic transpapillary mapping biopsy using the novel method were reviewed from August 2015 to June 2019. RESULTS : The median number of biopsy samples was six (range 1 - 17), and the rate of adequate sampling was 91.4 % (266 /291). Biopsy from the intrahepatic bile duct was possible in 82.0 % of patients (41 /50), and negative margins were confirmed in the resected specimens from 34 /39 patients who underwent surgery (87.2 %). None of the patients had post-endoscopic retrograde cholangiopancreatography pancreatitis. CONCLUSIONS : With our novel method, accurate assessment of the longitudinal extension of PHCC might be expected with minimal trauma to the duodenal papilla.
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Kamp EJCA, Dinjens WNM, Doukas M, Bruno MJ, de Jonge PJF, Peppelenbosch MP, de Vries AC. Optimal tissue sampling during ERCP and emerging molecular techniques for the differentiation of benign and malignant biliary strictures. Therap Adv Gastroenterol 2021; 14:17562848211002023. [PMID: 33948111 PMCID: PMC8053835 DOI: 10.1177/17562848211002023] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/15/2021] [Indexed: 02/04/2023] Open
Abstract
Patients with cholangiocarcinoma have poor survival since the majority of patients are diagnosed at a stage precluding surgical resection, due to locally irresectable tumors and/or metastases. Optimization of diagnostic strategies, with a principal role for tissue diagnosis, is essential to detect cancers at an earlier stage amenable to curative treatment. Current barriers for a tissue diagnosis include both insufficient tissue sampling and a difficult cyto- or histopathological assessment. During endoscopic retrograde cholangiopancreatography, optimal brush sampling includes obtaining more than one brush within an individual patient to increase its diagnostic value. Currently, no significant increase of the diagnostic accuracy for the new cytology brush devices aiming to enhance the cellularity of brushings versus standard biliary brush devices has been demonstrated. Peroral cholangioscopy with bile duct biopsies appears to be a valuable tool in the diagnostic work-up of indeterminate biliary strictures, and may overcome current technical difficulties of fluoroscopic-guided biopsies. Over the past years, molecular techniques to detect chromosomal instability, mutations and methylation profiling of tumors have revolutionized, and implementation of these techniques on biliary tissue during diagnostic work-up of biliary strictures may be awaited in the near future. Fluorescence in situ hybridization has already been implemented in routine diagnostic evaluation of biliary strictures in several centers. Next-generation sequencing is promising for standard diagnostic care in biliary strictures, and recent studies have shown adequate detection of prevalent genomic alterations in KRAS, TP53, CDKN2A, SMAD4, PIK3CA, and GNAS on biliary brush material. Detection of DNA methylation of tumor suppressor genes and microRNAs may evolve over the coming years to a valuable diagnostic tool for cholangiocarcinoma. This review summarizes optimal strategies for biliary tissue sampling during endoscopic retrograde cholangiopancreatography and focuses on the evolving molecular techniques on biliary tissue to improve the differentiation of benign and malignant biliary strictures.
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Affiliation(s)
- Eline J. C. A. Kamp
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Winand N. M. Dinjens
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, The Netherlands
| | - Michail Doukas
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, The Netherlands
| | - Marco J. Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Pieter Jan F. de Jonge
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Maikel P. Peppelenbosch
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Annemarie C. de Vries
- Department of Gastroenterology & Hepatology, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, Room Na-609, Rotterdam, 3015 GD, The Netherlands
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Tanisaka Y, Mizuide M, Fujita A, Ogawa T, Suzuki M, Katsuda H, Saito Y, Miyaguchi K, Tashima T, Mashimo Y, Ryozawa S. Diagnostic Process Using Endoscopy for Biliary Strictures: A Narrative Review. J Clin Med 2021; 10:jcm10051048. [PMID: 33802525 PMCID: PMC7961606 DOI: 10.3390/jcm10051048] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/17/2021] [Accepted: 02/27/2021] [Indexed: 12/13/2022] Open
Abstract
The diagnostic process for biliary strictures remains challenging in some cases. A broad differential diagnosis exists for indeterminate biliary strictures, including benign or malignant lesions. The diagnosis of indeterminate biliary strictures requires a combination of physical examination, laboratory testing, imaging modalities, and endoscopic procedures. Despite the progress of less invasive imaging modalities such as transabdominal ultrasonography, computed tomography, and magnetic resonance imaging, endoscopy plays an essential role in the accurate diagnosis, including the histological diagnosis. Imaging findings and brush cytology and/or forceps biopsy under fluoroscopic guidance with endoscopic retrograde cholangiopancreatography (ERCP) are widely used as the gold standard for the diagnosis of biliary strictures. However, ERCP cannot provide an intraluminal view of the biliary lesion, and its outcomes are not satisfactory. Recently, peroral cholangioscopy, confocal laser endomicroscopy, endoscopic ultrasound (EUS), and EUS-guided fine-needle aspiration have been reported as useful for indeterminate biliary strictures. Appropriate endoscopic modalities need to be selected according to the patient's condition, the lesion, and the expertise of the endoscopist. The aim of this review article is to discuss the diagnostic process for indeterminate biliary strictures using endoscopy.
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Ogawa T, Kanno Y, Koshita S, Masu K, Kusunose H, Sakai T, Yonamine K, Miyamoto K, Murabayashi T, Kozakai F, Endo K, Noda Y, Ito K. Cholangioscopy- versus fluoroscopy-guided transpapillary mapping biopsy for preoperative evaluation of extrahepatic cholangiocarcinoma: a prospective randomized crossover study. Surg Endosc 2020; 35:6481-6488. [PMID: 33141278 DOI: 10.1007/s00464-020-08141-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 10/27/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND To evaluate the lateral extent of extrahepatic cholangiocarcinoma, the value of cholangioscopy-guided mapping biopsy (CMB) compared with that of fluoroscopy-guided mapping biopsy (FMB) remains unknown. The aim of this study was to compare these two techniques. METHODS In this prospective, randomized, crossover study, both CMB and FMB techniques were performed for all patients in a randomized order. Target sites for the mapping biopsy were determined based on resection lines of possible surgical procedures. At least two biopsy strokes were attempted at each target site. The primary outcome was the rate of site-based successful biopsies, which was defined as acquisition of epithelium-containing material appropriate for diagnosing benignancy/malignancy from each site, regardless of amount of materials obtained from the same site. RESULTS Between September 2016 and October 2018, 28 patients (16 distal bile duct cancer and 12 perihilar bile duct cancer) were enrolled and divided into two groups of 14 patients: CMB first and FMB first. Although all 118 target sites could be approached using CMB, FMB forceps reached only 71% of them with significantly poor accessibility to the B2/3 confluence. Since several materials were too small and did not contain epithelium, the overall rates of site-based successful biopsies were 78% (92/118) using CMB and 64% (76/118) using FMB (P = 0.031). CONCLUSIONS The rate of site-based successful biopsies using CMB was significantly higher than that using FMB when evaluated using specimens obtained from several biopsy strokes.
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Affiliation(s)
- Takahisa Ogawa
- Department of Gastroenterology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan.
| | - Yoshihide Kanno
- Department of Gastroenterology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Shinsuke Koshita
- Department of Gastroenterology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Kaori Masu
- Department of Gastroenterology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Hiroaki Kusunose
- Department of Gastroenterology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Toshitaka Sakai
- Department of Gastroenterology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Keisuke Yonamine
- Department of Gastroenterology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Kazuaki Miyamoto
- Department of Gastroenterology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Toji Murabayashi
- Department of Gastroenterology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Fumisato Kozakai
- Department of Gastroenterology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Kazuki Endo
- Department of Gastroenterology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Yutaka Noda
- Department of Gastroenterology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
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Ishii Y, Serikawa M, Tsuboi T, Kawamura R, Tsushima K, Nakamura S, Hirano T, Fukiage A, Ikemoto J, Kiyoshita Y, Saeki S, Tamura Y, Chayama K. Usefulness of peroral cholangioscopy in the differential diagnosis of IgG4-related sclerosing cholangitis and extrahepatic cholangiocarcinoma: a single-center retrospective study. BMC Gastroenterol 2020; 20:287. [PMID: 32831026 PMCID: PMC7445926 DOI: 10.1186/s12876-020-01429-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 08/17/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND In the diagnosis of IgG4-related sclerosing cholangitis (IgG4-SC), differentiation from extrahepatic cholangiocarcinoma (ECC) is extremely important but is still a clinical challenge. This study aimed to elucidate the usefulness of peroral cholangioscopy (POCS) for the differential diagnosis between IgG4-SC and ECC. METHODS POCS findings for bile duct stricture were retrospectively evaluated in 17 patients with IgG4-SC diagnosed at the Hiroshima University Hospital and 53 patients with surgically resected infiltrating ECC. Mucosal surface, dilated vessels (tortuosity, caliber alteration, and disruption), and easily bleeding were compared between the groups. RESULTS The stricture sites of IgG4-SC evaluated by POCS were 10 extrapancreatic bile ducts and 9 intrapancreatic bile ducts. In patients with IgG4-SC, smooth mucosal surface was observed in 89% (17/19), dilated vessels in 58% (11/19) [tortuosity 82% (9/11), caliber alteration 18% (2/11), and disruption 9% (1/11)], and easily bleeding in 0%. Irregular mucosal surface and easily bleeding were observed significantly more frequently in ECC (both P < 0.001). The frequency of caliber alteration and disruption of dilated vessels was significantly less in IgG4-SC (P < 0.001 and 0.005, respectively). The sensitivity and specificity of POCS in the diagnosis of ECC were 96 and 89%, respectively. Dilated vessels in IgG4-SC were observed significantly more frequently in the extrapancreatic bile duct, especially the hilar bile duct (P = 0.006). Concerning image evaluation, the interobserver agreement was κ = 0.719, and the intraobserver agreement was κ = 0.768 and 0.754. CONCLUSIONS Characteristic POCS findings of the stricture sites in IgG4-SC were smooth mucosal surface, dilated vessels without caliber alteration and disruption, and lack of easily bleeding. These POCS findings are extremely useful for distinguishing between IgG4-SC and ECC.
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Affiliation(s)
- Yasutaka Ishii
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Masahiro Serikawa
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Tomofumi Tsuboi
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Ryota Kawamura
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Ken Tsushima
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Shinya Nakamura
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Tetsuro Hirano
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Ayami Fukiage
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Juri Ikemoto
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yusuke Kiyoshita
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Sho Saeki
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yosuke Tamura
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kazuaki Chayama
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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Onoyama T, Hamamoto W, Sakamoto Y, Kawahara S, Yamashita T, Koda H, Kawata S, Takeda Y, Matsumoto K, Isomoto H. Peroral cholangioscopy-guided forceps biopsy versus fluoroscopy-guided forceps biopsy for extrahepatic biliary lesions. JGH OPEN 2020; 4:1119-1127. [PMID: 33319046 PMCID: PMC7731811 DOI: 10.1002/jgh3.12403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 07/18/2020] [Accepted: 07/23/2020] [Indexed: 12/14/2022]
Abstract
Background and Aim Endoscopic retrograde cholangiopancreatography (ERCP)‐related tissue acquisition, including fluoroscopy‐guided forceps biopsy (F‐FB), is a common technique in diagnosing indeterminate biliary lesions. Recently, peroral cholangioscopy (POCS) and POCS‐guided forceps biopsy (POCS‐FB) has also been used for the diagnosis of indeterminate biliary lesions. However, it is uncertain which of those techniques were superior for the diagnosis of extrahepatic cholangiocarcinoma (ECC). We aimed to evaluate the diagnostic yield and safety of F‐FB for indeterminate biliary lesions compared with POCS‐FB. Methods Patients who underwent F‐FB or POCS‐FB to evaluate indeterminate biliary lesions between October 2011 and August 2019 were enrolled retrospectively. We carried out propensity score matching to balance these clinical differences between the F‐FB group and POCS‐FB group. In the propensity score‐matched cohort, we compared the diagnostic performance of F‐FB with that of POCS‐FB based on the pathological evaluation. We also evaluate adverse events associated with F‐FB and POCS‐FB. Results We enrolled 113 patients with biliary diseases, and 62 patients were analyzed in the propensity score‐matched cohort. Sensitivity, specificity, and accuracy of F‐FB were 82.4, 100, and 90.3%, and for POCS‐FB, those values were 83.3, 100, and 90.3%, respectively. There were no significant differences in the diagnostic performance between F‐FB and POCS‐FB. There were also no significant differences in the occurrence of adverse events between F‐FB and POCS‐FB (41.9 vs 29.0%, P = 0.289). Conclusions The diagnostic yield of F‐FB for ECC is similar to that of POCS‐FB. POCS‐FB is not necessary for the initial pathological diagnosis of indeterminate biliary lesions.
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Affiliation(s)
- Takumi Onoyama
- Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine Tottori University Faculty of Medicine Yonago Japan
| | - Wataru Hamamoto
- Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine Tottori University Faculty of Medicine Yonago Japan
| | - Yuri Sakamoto
- Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine Tottori University Faculty of Medicine Yonago Japan
| | - Shiho Kawahara
- Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine Tottori University Faculty of Medicine Yonago Japan
| | - Taro Yamashita
- Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine Tottori University Faculty of Medicine Yonago Japan
| | - Hiroki Koda
- Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine Tottori University Faculty of Medicine Yonago Japan
| | - Soichiro Kawata
- Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine Tottori University Faculty of Medicine Yonago Japan
| | - Yohei Takeda
- Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine Tottori University Faculty of Medicine Yonago Japan
| | - Kazuya Matsumoto
- Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine Tottori University Faculty of Medicine Yonago Japan
| | - Hajime Isomoto
- Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine Tottori University Faculty of Medicine Yonago Japan
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Fukasawa Y, Takano S, Fukasawa M, Maekawa S, Kadokura M, Shindo H, Takahashi E, Hirose S, Kawakami S, Hayakawa H, Yamaguchi T, Nakayama Y, Inoue T, Sato T, Enomoto N. Form-Vessel Classification of Cholangioscopy Findings to Diagnose Biliary Tract Carcinoma's Superficial Spread. Int J Mol Sci 2020; 21:ijms21093311. [PMID: 32392821 PMCID: PMC7246671 DOI: 10.3390/ijms21093311] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 04/29/2020] [Accepted: 05/05/2020] [Indexed: 12/15/2022] Open
Abstract
We aimed to evaluate a newly developed peroral cholangioscopy (POCS) classification system by comparing classified lesions with histological and genetic findings. We analyzed 30 biopsied specimens from 11 patients with biliary tract cancer (BTC) who underwent POCS. An original classification of POCS findings was made based on the biliary surface's form (F factor, 4 grades) and vessel structure (V-factor, 3 grades). Findings were then compared with those of corresponding biopsy specimens analyzed histologically and by next-generation sequencing to identify somatic mutations. In addition, the histology of postoperative surgical stumps and preoperative POCS findings were compared. Histological malignancy rate in biopsied specimens increased with increasing F- and V-factor scores (F1, 0%; F1, 25%; F3, 50%; F4, 62.5%; p = 0.0015; V1, 0%; V2, 20%; V3, 70%; p < 0.001). Furthermore, we observed a statistically significant increase of the mutant allele frequency of mutated genes with increasing F- and V-factor scores (F factor, p = 0.0050; V-factor, p < 0.001). All surgical stumps were accurately diagnosed using POCS findings. The F-V classification of POCS findings is both histologically and genetically valid and will contribute to the methods of diagnosing the superficial spread of BTC tumors.
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Chaudhary RJ, Higuchi R, Nagino M, Unno M, Ohtsuka M, Endo I, Hirano S, Uesaka K, Hasegawa K, Wakai T, Uemoto S, Yamamoto M. Survey of preoperative management protocol for perihilar cholangiocarcinoma at 10 Japanese high-volume centers with a combined experience of 2,778 cases. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2019; 26:490-502. [PMID: 31520452 DOI: 10.1002/jhbp.668] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND In Japan, strategies for preoperative management of perihilar cholangiocarcinoma (PHC) have evolved over the last decade; the operative mortality has significantly reduced to <5%. METHODS A questionnaire was sent to 10 institutions based on their case volume. Questionnaire was based on: (1) preoperative biliary drainage, (2) bile replacement, (3) role of synbiotics, (4) remnant liver volume enhancement, (5) predicted remnant liver function, (6) imaging, (7) nutrition, and (8) role of Inchinkoto. RESULTS The median case volume was 226 (range 105-889) cases, respectively. Eight institutions preferred endoscopic nasobiliary drainage and two preferred endoscopic biliary stenting for biliary drainage. Nine used bile replacement within 2-3 days of biliary drainage. Four used synbiotics preoperatively. The median cutoff value for future remnant liver volume and serum total bilirubin, at which portal vein embolization (PVE) is done, is <40% and <4 mg/dl. The median interval between PVE and surgery was 3-4 weeks. To predict remnant liver function, indocyanine green retention (n = 8) and clearance rate (n = 2) were mainly used. Five used Inchinkoto to improve liver function. Nine used multidetector computed tomography and direct cholangiography for surgical planning. CONCLUSION With appropriate preoperative management of PHC, surgical morbidity and mortality can be reduced. This survey can provide recommendations to improve PHC perioperative outcomes.
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Affiliation(s)
- Rohan Jagat Chaudhary
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Ryota Higuchi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Masato Nagino
- Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masayuki Ohtsuka
- Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Itaru Endo
- Department of Gastrointestinal Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | | | | | - Kiyoshi Hasegawa
- HPB Division, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshifumi Wakai
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | | | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
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Navaneethan U, Moon JH, Itoi T. Biliary interventions using single-operator cholangioscopy. Dig Endosc 2019; 31:517-526. [PMID: 30689238 DOI: 10.1111/den.13361] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 01/23/2019] [Indexed: 12/15/2022]
Abstract
Cholangioscopy provides an opportunity to directly visualize the bile duct for diagnosing biliary lesions and for therapeutic interventions. Although there are different cholangioscopy techniques available, single-operator cholangioscopy has gained widespread acceptance as the standard technique for interventions in the biliary system because of its ease of use and widespread availability. Single-operator cholangioscopy can be used for both diagnostic and therapeutic indications in the biliary tract. Diagnostic cholangioscopy is used for direct evaluation of indeterminate bile duct strictures with biopsies, diagnosing filling defects in the bile ducts observed during endoscopic retrograde cholangiography (ERC) imaging, preoperative mapping of the precise location and extension of tumors of the biliary tract, and diagnosis of intraductal neoplasms. Therapeutic cholangioscopy is used for visually guided treatment of biliary stones that have failed extraction with conventional ERC techniques, residual or impacted stones by using intraductal lithotripsy, ablation of biliary tumors and for facilitation of guidewire advancement into selective intrahepatic ducts for adequate biliary drainage. In this review, we will focus on advances in the single-operator cholangioscopy techniques in the diagnosis and management of biliary disorders.
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Affiliation(s)
| | - Jong Ho Moon
- Department of Gastroenterology, Soon Chun Hyang University School of Medicine, Bucheon, Korea
| | - Takao Itoi
- Department of Gastroenterology, Tokyo Medical University, Tokyo, Japan
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Intracholecystic papillary-tubular neoplasm of the gallbladder originating in the cystic duct with extensive intraepithelial progress in the common bile duct. Clin J Gastroenterol 2018; 12:197-204. [DOI: 10.1007/s12328-018-0927-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 11/16/2018] [Indexed: 01/04/2023]
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24
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Kanno Y, Koshita S, Ogawa T, Masu K, Kusunose H, Sakai T, Murabayashi T, Haegawa S, Kozakai F, Yonamine K, Kawakami Y, Fujii Y, Horaguchi J, Noda Y, Ito K. Peroral cholangioscopy by SpyGlass DS versus CHF-B260 for evaluation of the lateral spread of extrahepatic cholangiocarcinoma. Endosc Int Open 2018; 6:E1349-E1354. [PMID: 30410956 PMCID: PMC6221821 DOI: 10.1055/a-0743-5283] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 07/24/2018] [Indexed: 01/16/2023] Open
Abstract
Background and study aims A newly developed peroral cholangioscopy (POCS) system, SpyGlassDS has high maneuverability. This study aimed to evaluate acceptability of the accuracy of SpyGlassDS accompanied by simultaneous POCS-guided biopsy compared with that of a traditional POCS scope, CHF-B260, to diagnose the lateral extent of extrahepatic cholangiocarcinoma (LEC). Patients and methods Patients who underwent surgical resection after preoperative examinations to diagnose LEC were evaluated. POCS by CHF-B260 was performed if there was discrepancy between preceding fluoroscopy-guided biopsy findings and other examinations between January 2004 and September 2015 (group A, n = 56); and POCS plus POCS-guided mapping biopsy by SpyGlassDS was performed in all surgical candidates between October 2015 and December 2017 (group B, n = 20). The main outcome measure was the accuracy of overall preoperative diagnosis (OPD) of LEC defined based on all examinations, including POCS. Results Accuracy of OPD for the liver side and the ampullary side was 93 % and 100 %, respectively, in group A, and 84 % and 100 %, respectively, in group B ( P = 0.37 for the liver side; P , not available for the ampullary side). Diagnostic accuracy of simple optical evaluation by POCS for the liver side and the ampullary side was 83 % and 100 %, respectively, in group A, and 58 % and 88 %, respectively, in group B ( P = 0.29 for the liver side; P = 0.40 for the ampullary side). Conclusions POCS by SpyGlassDS was found to be acceptable and could be a standard approach for diagnosis of LEC.
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Affiliation(s)
- Yoshihide Kanno
- Sendai City Medical Center – Gastroenterology, Sendai, Japan
| | | | - Takahisa Ogawa
- Sendai City Medical Center – Gastroenterology, Sendai, Japan
| | - Kaori Masu
- Sendai City Medical Center – Gastroenterology, Sendai, Japan
| | | | - Toshitaka Sakai
- Sendai City Medical Center – Gastroenterology, Sendai, Japan
| | | | - Sho Haegawa
- Sendai City Medical Center – Gastroenterology, Sendai, Japan
| | | | | | - Yujiro Kawakami
- Sendai City Medical Center – Gastroenterology, Sendai, Japan
| | - Yuki Fujii
- Sendai City Medical Center – Gastroenterology, Sendai, Japan
| | - Jun Horaguchi
- Sendai City Medical Center – Gastroenterology, Sendai, Japan,Natori Chuo Clinic – Gastroenterology, Natori, Japan
| | - Yutaka Noda
- Sendai City Medical Center – Gastroenterology, Sendai, Japan
| | - Kei Ito
- Sendai City Medical Center – Gastroenterology, Sendai, Japan
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Ishida Y, Okabe Y, Yasumoto M, Naito Y, Nakama Y, Kitasato Y, Ishikawa H, Hisaka T, Tsuruta O, Torimura T. Ex vivo magnifying endoscopic observation of bile duct mucosa using narrowband imaging. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2018; 25:433-439. [DOI: 10.1002/jhbp.581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Yusuke Ishida
- Division of Gastroenterology; Department of Medicine; Kurume University School of Medicine; 67 Asahi-machi Kurume Fukuoka 830-0011 Japan
| | - Yoshinobu Okabe
- Division of Gastroenterology; Department of Medicine; Kurume University School of Medicine; 67 Asahi-machi Kurume Fukuoka 830-0011 Japan
| | - Makiko Yasumoto
- Division of Gastroenterology; Department of Medicine; Kurume University School of Medicine; 67 Asahi-machi Kurume Fukuoka 830-0011 Japan
| | - Yoshiki Naito
- Department of Diagnostic Pathology; Kurume University Hospital; Kurume Fukuoka Japan
| | - Yohei Nakama
- Department of Surgery; Iizuka City Hospital; Iizuka Fukuoka Japan
| | - Yuhei Kitasato
- Department of Surgery; Kurume University School of Medicine; Kurume Fukuoka Japan
| | - Hiroto Ishikawa
- Department of Surgery; Kurume University School of Medicine; Kurume Fukuoka Japan
| | - Toru Hisaka
- Department of Surgery; Kurume University School of Medicine; Kurume Fukuoka Japan
| | - Osamu Tsuruta
- Division of Gastroenterology; Department of Medicine; Kurume University School of Medicine; 67 Asahi-machi Kurume Fukuoka 830-0011 Japan
| | - Takuji Torimura
- Division of Gastroenterology; Department of Medicine; Kurume University School of Medicine; 67 Asahi-machi Kurume Fukuoka 830-0011 Japan
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26
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Yao S, Taura K, Okuda Y, Kodama Y, Uza N, Gouda N, Minamiguchi S, Okajima H, Kaido T, Uemoto S. Effect of mapping biopsy on surgical management of cholangiocarcinoma. J Surg Oncol 2018; 118:997-1005. [DOI: 10.1002/jso.25226] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 08/14/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Siyuan Yao
- Department of Surgery; Graduate School of Medicine, Kyoto University; Kyoto Japan
| | - Kojiro Taura
- Department of Surgery; Graduate School of Medicine, Kyoto University; Kyoto Japan
| | - Yukihiro Okuda
- Department of Surgery; Graduate School of Medicine, Kyoto University; Kyoto Japan
| | - Yuzo Kodama
- Department of Gastroenterology; Graduate School of Medicine, Kobe University; Hyogo Japan
| | - Norimitsu Uza
- Department of Gastroenterology and Hepatology; Graduate School of Medicine, Kyoto University; Kyoto Japan
| | - Naoki Gouda
- Department of Diagnostic Pathology; Graduate School of Medicine, Kyoto University; Kyoto Japan
| | - Sachiko Minamiguchi
- Department of Diagnostic Pathology; Graduate School of Medicine, Kyoto University; Kyoto Japan
| | - Hideaki Okajima
- Department of Surgery; Graduate School of Medicine, Kyoto University; Kyoto Japan
| | - Toshimi Kaido
- Department of Surgery; Graduate School of Medicine, Kyoto University; Kyoto Japan
| | - Shinji Uemoto
- Department of Surgery; Graduate School of Medicine, Kyoto University; Kyoto Japan
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27
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Inoue T, Kitano R, Kobayashi Y, Ishii N, Sakamoto K, Ohashi T, Nakade Y, Sumida Y, Ito K, Nakao H, Yoneda M. Assessing the diagnostic yield of controllable biopsy-forceps for biliary strictures. Scand J Gastroenterol 2018; 53:598-603. [PMID: 29183203 DOI: 10.1080/00365521.2017.1409799] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Biliary forceps biopsies are essential for differentially diagnosing biliary strictures and evaluating the preoperative superficial intraductal spread of bile duct cancers; however, these biopsies are technically demanding and time consuming. Using controllable biopsy-forceps (C-BF), which enable the tip's angle to be adjusted by up to 90°, may facilitate the procedure and improve the diagnostic yield for biliary biopsies. This study aimed to examine the efficacy of C-BF associated with the diagnosis of biliary strictures. MATERIALS AND METHOD Between 2009 and 2015, 110 patients with biliary strictures underwent biliary biopsies using C-BF. We retrospectively evaluated the diagnostic yield of C-BF for biliary strictures and determined the success rate associated with obtaining adequate samples during mapping biopsies to evaluate the superficial intraductal tumor spread. RESULTS The technical success rate for biliary biopsies using C-BF was 99% (109/110). The sensitivity, specificity and accuracy of the diagnoses of biliary strictures were 60% (46/77), 100% (33/33) and 72% (79/110), respectively. Regarding the mapping biopsy procedures, adequate samples were successfully obtained from 96% (22/23), 92% (11/12), 80% (12/15), 75% (9/12) and 31% (5/16) of the intrapancreatic common bile ducts, upper common bile ducts, confluences of the hepatic ducts, right intrahepatic bile ducts and left intrahepatic bile ducts, respectively. CONCLUSIONS C-BF may facilitate biliary cannulation and mapping biopsies of the common bile duct and the right intrahepatic bile duct. However, given that the diagnostic sensitivity was 60%, further modifications are expected and necessary to maximize the utility of the controllable mechanism.
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Affiliation(s)
- Tadahisa Inoue
- a Department of Gastroenterology , Aichi Medical University School of Medicine , Nagakute , Japan
| | - Rena Kitano
- a Department of Gastroenterology , Aichi Medical University School of Medicine , Nagakute , Japan
| | - Yuji Kobayashi
- a Department of Gastroenterology , Aichi Medical University School of Medicine , Nagakute , Japan
| | - Norimitsu Ishii
- a Department of Gastroenterology , Aichi Medical University School of Medicine , Nagakute , Japan
| | - Kazumasa Sakamoto
- a Department of Gastroenterology , Aichi Medical University School of Medicine , Nagakute , Japan
| | - Tomohiko Ohashi
- a Department of Gastroenterology , Aichi Medical University School of Medicine , Nagakute , Japan
| | - Yukiomi Nakade
- a Department of Gastroenterology , Aichi Medical University School of Medicine , Nagakute , Japan
| | - Yoshio Sumida
- a Department of Gastroenterology , Aichi Medical University School of Medicine , Nagakute , Japan
| | - Kiyoaki Ito
- a Department of Gastroenterology , Aichi Medical University School of Medicine , Nagakute , Japan
| | - Haruhisa Nakao
- a Department of Gastroenterology , Aichi Medical University School of Medicine , Nagakute , Japan
| | - Masashi Yoneda
- a Department of Gastroenterology , Aichi Medical University School of Medicine , Nagakute , Japan
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Ogawa T, Ito K, Koshita S, Kanno Y, Masu K, Kusunose H, Sakai T, Murabayashi T, Hasegawa S, Noda Y. Usefulness of cholangioscopic-guided mapping biopsy using SpyGlass DS for preoperative evaluation of extrahepatic cholangiocarcinoma: a pilot study. Endosc Int Open 2018; 6:E199-E204. [PMID: 29399618 PMCID: PMC5794453 DOI: 10.1055/s-0043-117949] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 06/22/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND STUDY AIMS Evaluation of longitudinal tumor extent is indispensable for curative surgical treatment of extrahepatic cholangiocarcinoma. The aim of this study was to evaluate the usefulness and feasibility of cholangioscopic-guided mapping biopsy using a newly developed peroral digital cholangioscope, SpyGlass DS (SpyDS), for preoperative evaluation of extrahepatic cholangiocarcinoma. PATIENTS AND METHODS Thirteen patients (mean age, 75 years; male 10, female 3) with extrahepatic cholangiocarcinoma who underwent cholangioscopic-guided mapping biopsy using SpyDS for preoperative evaluation were included in this study. Successful cholangioscopic-guided mapping biopsy was defined as the acquisition of specimens sufficient for histopathological diagnosis. RESULTS The mean number of biopsies was 5 per patient. The overall success rate for cholangioscopic-guided mapping biopsy was 88 % (59/67). The success rate for cholangioscopic-guided mapping biopsy from the confluence of the right and left hepatic ducts was 89 %, that from the B4 confluence was 93 %, that from the confluence of the right anterior and right posterior segmental ducts was 86 %, that from the intrapancreatic common bile duct was 67 %, and that from the main lesion was 100 %. The overall diagnostic accuracy of longitudinal tumor extent at the hepatic side, the duodenal side and overall by cholangioscopic findings and mapping biopsy, was 88 % (7/8), 88 % (7/8) and 88 % (7/8), respectively. Assessment according to location of the main lesion revealed that diagnostic accuracy in the patients with distal bile duct carcinoma was 100 % (5/5) and that in patients with perihilar bile duct carcinoma was 66 % (2/3). Complications after the procedure did not occur in any patients. CONCLUSIONS Cholangioscopic-guided mapping biopsy using SpyDS is thought to be feasible for preoperative evaluation of extrahepatic cholangiocarcinoma.
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Affiliation(s)
- Takahisa Ogawa
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan,Corresponding author Takahisa Ogawa Sendai City Medical Center5-22-1, TsurugayaMiyagino-kuSendai 983-0824, Japan+81-22-252-9431
| | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Shinsuke Koshita
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Yoshihide Kanno
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Kaori Masu
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Hiroaki Kusunose
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Toshitaka Sakai
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Toji Murabayashi
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Sho Hasegawa
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Yutaka Noda
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
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Abstract
Primary sclerosing cholangitis (PSC) remains a rare but potentially devastating chronic, cholestatic liver disease. PSC causes obstruction of intra- and/or extra-hepatic bile ducts by inflammation and fibrosis, leading to biliary obstruction, cirrhosis and portal hypertension with all associated sequelae. The most dreaded consequence of PSC is cholangiocarcinoma, occurring in 10-20% of patients with PSC, and with population-based estimates of a 398-fold increased risk of cholangiocarcinoma in patients with PSC compared to the general population. We use the 4-D approach to endoscopic evaluation and management of PSC based on currently available evidence. After laboratory testing with liver chemistries and high-quality cross-sectional imaging with MRCP, the first D is Dominant stricture diagnosis and evaluation. Second, Dilation of strictures found during ERCP is performed using balloon dilation to as many segments as possible. Third, Dysplasia and cholangiocarcinoma diagnosis is performed by separated brushings for conventional cytology and fluorescence in situ hybridization (FISH), and consideration for direct cholangioscopy with SpyGlass™. Fourt and finally, Dosing of antibiotics is critical to prevent peri-procedural cholangitis. The aim of this review article is to explore endoscopic tools and techniques for the diagnosis and management of PSC and provide a practical approach for clinicians.
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Affiliation(s)
- Jodie A Barkin
- University of Miami, Leonard M. Miller School of Medicine, Department of Medicine, Division of Gastroenterology. Miami, Florida, USA
| | - Cynthia Levy
- University of Miami, Leonard M. Miller School of Medicine, Department of Medicine, Division of Hepatology. Miami, Florida, USA
| | - Enrico O Souto
- University of Miami, Leonard M. Miller School of Medicine, Department of Medicine, Division of Gastroenterology. Miami, Florida, USA
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30
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Aabakken L, Karlsen TH, Albert J, Arvanitakis M, Chazouilleres O, Dumonceau JM, Färkkilä M, Fickert P, Hirschfield GM, Laghi A, Marzioni M, Fernandez M, Pereira SP, Pohl J, Poley JW, Ponsioen CY, Schramm C, Swahn F, Tringali A, Hassan C. Role of endoscopy in primary sclerosing cholangitis: European Society of Gastrointestinal Endoscopy (ESGE) and European Association for the Study of the Liver (EASL) Clinical Guideline. J Hepatol 2017; 66:1265-1281. [PMID: 28427764 DOI: 10.1016/j.jhep.2017.02.013] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 02/14/2017] [Indexed: 02/06/2023]
Abstract
This guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE) and of the European Association for the Study of the Liver (EASL) on the role of endoscopy in primary sclerosing cholangitis. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was adopted to define the strength of recommendations and the quality of evidence. Main recommendations.
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31
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Thaker AM, Muthusamy VR. The role and utility of cholangioscopy for diagnosing indeterminate biliary strictures. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2017. [DOI: 10.18528/gii160035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Adarsh M. Thaker
- Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - V. Raman Muthusamy
- Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Sakai Y, Tsuyuguchi T, Hirata N, Nakaji S, Shimura K, Nishikawa T, Fujimoto T, Hamano T, Nishino T, Yokosuka O. Clinical utility of 0.025-inch guidewire VisiGlide2 TM in the endoscopic retrograde cholangiopancreatography-related procedures. World J Gastrointest Endosc 2017; 9:77-84. [PMID: 28250900 PMCID: PMC5311476 DOI: 10.4253/wjge.v9.i2.77] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 09/23/2016] [Accepted: 11/02/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To examine the result of the use of 0.025-inch guidewire (GW) VisiGlide2TM as the first choice in the endoscopic retrograde cholangiopancreatography (ERCP)-related procedures without selecting the patient in a multicenter prospective study.
METHODS ERCP using 0.025-inch GW VisiGlide2TM as the first choice was conducted in patients who have needed ERCP, and its accomplishment rate of procedure, procedural time, incidence of accidental symptoms were compared with those of ERCP using 0.025-inch GW VisiGlideTM.
RESULTS The accomplishment rate of procedure was 97.5% (197/202), and procedural time was 23.930 ± 16.207 min. The accomplishment rate of procedure using 0.025-inch GW VisiGlideTM was 92.3% (183/195), and procedural time was 31.285 ± 19.122 min, thus the accomplishment rate of procedure was significantly improved and procedural time was significantly shortened (P < 0.05). Accidental symptoms by ERCP-related procedures were observed in 3.0% (6/202), and all were conservatively alleviated.
CONCLUSION When 0.025-inch GW VisiGlide2TM was used for ERCP-related procedure as the first choice, it showed high accomplishment rate of procedure and low incidence of accidental symptoms, suggesting it can be used as the universal GW. Clinical Trial Registry (UMIN0000016042).
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Kawakubo K, Kawakami H, Kuwatani M, Haba S, Kudo T, Taya YA, Kawahata S, Kubota Y, Kubo K, Eto K, Ehira N, Yamato H, Onodera M, Sakamoto N. Lower incidence of complications in endoscopic nasobiliary drainage for hilar cholangiocarcinoma. World J Gastrointest Endosc 2016; 8:385-390. [PMID: 27170839 PMCID: PMC4861855 DOI: 10.4253/wjge.v8.i9.385] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 02/15/2016] [Accepted: 03/14/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To identify the most effective endoscopic biliary drainage technique for patients with hilar cholangiocarcinoma. METHODS In total, 118 patients with hilar cholangiocarcinoma underwent endoscopic management [endoscopic nasobiliary drainage (ENBD) or endoscopic biliary stenting] as a temporary drainage in our institution between 2009 and 2014. We retrospectively evaluated all complications from initial endoscopic drainage to surgery or palliative treatment. The risk factors for biliary reintervention, post-endoscopic retrograde cholangiopancreatography (post-ERCP) pancreatitis, and percutaneous transhepatic biliary drainage (PTBD) were also analyzed using patient- and procedure-related characteristics. The risk factors for bilateral drainage were examined in a subgroup analysis of patients who underwent initial unilateral drainage. RESULTS In total, 137 complications were observed in 92 (78%) patients. Biliary reintervention was required in 83 (70%) patients. ENBD was significantly associated with a low risk of biliary reintervention [odds ratio (OR) = 0.26, 95%CI: 0.08-0.76, P = 0.012]. Post-ERCP pancreatitis was observed in 19 (16%) patients. An absence of endoscopic sphincterotomy was significantly associated with post-ERCP pancreatitis (OR = 3.46, 95%CI: 1.19-10.87, P = 0.023). PTBD was required in 16 (14%) patients, and Bismuth type III or IV cholangiocarcinoma was a significant risk factor (OR = 7.88, 95%CI: 1.33-155.0, P = 0.010). Of 102 patients with initial unilateral drainage, 49 (48%) required bilateral drainage. Endoscopic sphincterotomy (OR = 3.24, 95%CI: 1.27-8.78, P = 0.004) and Bismuth II, III, or IV cholangiocarcinoma (OR = 34.69, 95%CI: 4.88-736.7, P < 0.001) were significant risk factors for bilateral drainage. CONCLUSION The endoscopic management of hilar cholangiocarcinoma is challenging. ENBD should be selected as a temporary drainage method because of its low risk of complications.
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Ishida Y, Itoi T, Okabe Y. Types of Peroral Cholangioscopy: How to Choose the Most Suitable Type of Cholangioscopy. ACTA ACUST UNITED AC 2016; 14:210-9. [PMID: 27053226 DOI: 10.1007/s11938-016-0090-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OPINION STATEMENT A number of case studies have described the usefulness of peroral cholangioscopy for diagnosis and therapy, performed by visualizing the inner cavity of the bile duct. Currently available types of peroral cholangioscopy include peroral videocholangioscopy (POCS) using a mother-baby scope system (MBSS), direct peroral videocholangioscopy (D-POCS), and SpyGlass™ Direct Visualization System (SGDVS). POCS started with cholangioscopy using MBSS, requiring two skilled endoscopists using two endoscopic systems. On the other hand, D-POCS and SGDVS were developed as single-operator techniques. In MBSS, the videocholangioscope is inserted into the bile duct through the accessory channel of a conventional therapeutic duodenoscope. MBSS enables comparatively easy scope insertion into the bile duct and stable scope positioning. POCS using MBSS provides excellent images and can be coupled with an image-enhanced function system. However, it has a smaller accessory channel, limiting the devices that can be used. Additionally, scope fragility is serious problem. D-POCS using an ultraslim upper endoscope has been introduced to overcome the drawback of POCS using MBSS. D-POCS has a larger working channel and requires only one endoscopist. D-POCS allows a greater variety of procedures under excellent imaging even with an image-enhanced function system; however, scope insertion is still challenging. SGDVS is designed for single-operator use and is dedicated to procedural purposes. It comprises a reusable optical probe and disposable delivery catheter, which has four-way deflected steering and dedicated irrigation channels. These features lead to good maneuverability, although image quality is poor due to its optical probe system. All systems' features should be recognized and the appropriate system used depending on the need. Cholangioscopy has shown dramatic progress from diagnosis to therapy with high future growth potential.
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Affiliation(s)
- Yusuke Ishida
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
| | - Yoshinobu Okabe
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
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Zen Y, Kawakami H, Kim JH. IgG4-related sclerosing cholangitis: all we need to know. J Gastroenterol 2016; 51:295-312. [PMID: 26817943 DOI: 10.1007/s00535-016-1163-7] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 12/24/2015] [Indexed: 02/04/2023]
Abstract
Our knowledge and experience of IgG4-related sclerosing cholangitis (ISC) have expanded in the last decade. ISC is one of the common organ manifestations of IgG4-related disease (IgG4-RD); approximately 60 % of patients with this systemic condition have ISC in the proximal and/or distal bile ducts. ISC needs to be discriminated from primary sclerosing cholangitis, cholangiocarcinoma, and other rare forms of lymphoplasmacytic cholangiopathy (e.g., follicular cholangitis and sclerosing cholangitis with granulocytic epithelial lesions). Its diagnosis requires a multidisciplinary approach, in which serology, histology, and imaging play crucial roles. Treatments with high-dose corticosteroids typically lead to the rapid and consistent induction of disease remission. Another promising therapeutic approach is B-cell depletion with rituximab. Although disease relapse is relatively common, provided that appropriate treatments are administered, ISC is considered a "benign" disease with a low risk of liver failure and biliary malignancy. Its molecular pathology is characterized by Th2-dominant immune reactions, regulatory T-cell activation, and CCL1-CCR8 interactions. Particular subsets of B cells such as plasmablasts and regulatory B cells also expand. A recent global proteomic study demonstrated that three significantly activated immunological cascades in ISC were all B-cell- or immunoglobulin-related (Fc-gamma receptor-mediated phagocytosis, B-cell receptor signaling pathway, and Fc-epsilon receptor I signaling pathway), suggesting the crucial roles of B cells in the underlying immune reactions. Despite the expansion of our knowledge of the pathophysiology of ISC, the exact role of IgG4 remains unclear. A better understanding of its immunopathology will offer some potential drug targets for this emerging biliary disease.
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Affiliation(s)
- Yoh Zen
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Kobe, 650-0017, Japan.
| | - Hiroshi Kawakami
- Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo, Japan
| | - Jung Hoon Kim
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
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Choi HJ, Moon JH, Lee YN. Advanced Imaging Technology in Biliary Tract Diseases:Narrow-Band Imaging of the Bile Duct. Clin Endosc 2015; 48:498-502. [PMID: 26668795 PMCID: PMC4676665 DOI: 10.5946/ce.2015.48.6.498] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 11/04/2015] [Accepted: 11/04/2015] [Indexed: 12/27/2022] Open
Abstract
Newly introduced direct peroral cholangioscopy and the development of video choledochoscopes have enabled more defined observation of bile duct mucosal lesions with clearer images. Narrow-band imaging (NBI) is a unique endoscopic imaging technology that provides enhanced endoscopic images of surface mucosal structures and its superficial microvessels. Advanced cholangioscopy and NBI are expected to be useful for precise evaluation and correct diagnosis of biliary tract diseases. However, the diagnostic value of advanced bile duct imaging with cholangioscopy requires further evaluation.
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Affiliation(s)
- Hyun Jong Choi
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Jong Ho Moon
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Yun Nah Lee
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon, Korea
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Lee DW, Kim HG. Can Endoscopic Nasobiliary Drainage Involving Two Catheters Be Used to Treat Various Conditions? Clin Endosc 2015; 48:464-5. [PMID: 26668790 PMCID: PMC4676669 DOI: 10.5946/ce.2015.48.6.464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 11/17/2015] [Accepted: 11/17/2015] [Indexed: 11/16/2022] Open
Affiliation(s)
- Dong Wook Lee
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Ho Gak Kim
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
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Ishida Y, Itoi T, Okabe Y. Can image-enhanced cholangioscopy distinguish benign from malignant lesions in the biliary duct? Best Pract Res Clin Gastroenterol 2015; 29:611-25. [PMID: 26381306 DOI: 10.1016/j.bpg.2015.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 04/17/2015] [Accepted: 05/21/2015] [Indexed: 01/31/2023]
Abstract
A new video peroral cholangioscopy (POCS) has been developed with high-quality digital imaging, and its clinical use has been reported. Additionally, direct peroral cholangioscopy (D-POCS) using an ultraslim endoscope has been proposed recently. To improve the diagnostic yield of POCS or D-POCS, image-enhanced endoscopy has been used in combination. Chromoendoscopy with methylene blue staining (ME), autofluorescence imaging (AFI), and narrow-band imaging (NBI) has been evaluated in biliary tract diseases. Observation of the mucosal structure and vessels is reportedly important for distinguishing non-neoplasms from neoplasms. Therefore, NBI is the most promising tool among image-enhanced endoscopies as it can enhance visualization of the mucosal structure and vessels simultaneously. There are currently few reports that have evaluated the utility of POCS or D-POCS based on pathological findings. Thus, endoscopic findings of the bile duct mucosa have not yet been fully established. At present, POCS-guided biopsy should be carried out.
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Affiliation(s)
- Yusuke Ishida
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Fukuoka, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan.
| | - Yoshinobu Okabe
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Fukuoka, Japan
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Sun X, Zhou Z, Tian J, Wang Z, Huang Q, Fan K, Mao Y, Sun G, Yang Y. Is single-operator peroral cholangioscopy a useful tool for the diagnosis of indeterminate biliary lesion? A systematic review and meta-analysis. Gastrointest Endosc 2015; 82:79-87. [PMID: 25841576 DOI: 10.1016/j.gie.2014.12.021] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Accepted: 12/04/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Differentiating between malignant and benign biliary lesions is critical in clinical practice but is difficult. OBJECTIVE To systematically evaluate the diagnostic performance of single-operator peroral cholangioscopy on indeterminate biliary lesions. DESIGN A systematic review and meta-analysis. PATIENTS Patients with indeterminate biliary lesions or equivocal ERCP findings. MAIN OUTCOME MEASUREMENTS The diagnostic performance of single-operator peroral cholangioscopy on indeterminate biliary lesions. The area under the summary receiver-operating characteristic curve was used as the main indicator for the overall diagnostic performance of single-operator peroral cholangioscopy visual impression (VI) and SpyBite biopsy (SB). The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were also synthesized. RESULTS A total of 8 studies met the inclusion criteria, involving 335 patients who had data on VI and 337 who had data on SB. The area under the curve values on the summary receiver-operating characteristic curve of single-operator peroral cholangioscopy VI and SB were 0.94 (95% confidence interval [CI], 0.92-0.96) and 0.93 (95% CI, 0.90-0.95) respectively. The combined sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were 90% (95% CI, 73%-97%), 87% (95% CI, 76%-94%), 7.1 (95% CI, 3.8-13.3), 0.12 (95% CI, 0.04-0.33) for VI and 69% (95% CI, 57%-79%), 98% (95% CI, 92%-99%), 30.1 (95% CI, 8.5-106.9), and 0.32 (95% CI, 0.23-0.44) for SB, respectively. LIMITATIONS Small number of included studies; comparison with ERCP could not be made. CONCLUSION Single-operator peroral cholangioscopy is a good tool for differentiating malignant and benign biliary lesions. VI is useful for detecting malignant lesion, whereas SB is better at confirming a malignant diagnosis, but VI is not perfect in excluding biliary cancer, nor is SB, and their negative results should be interpreted with caution.
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Affiliation(s)
- Xi Sun
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China; Nanlou Digestive Endoscopy Center, Chinese PLA General Hospital, Beijing, China
| | - Zhirui Zhou
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jianmin Tian
- St. Vincent Hospital, Indianapolis, Indiana, USA
| | - Zhiqiang Wang
- Nanlou Digestive Endoscopy Center, Chinese PLA General Hospital, Beijing, China
| | - Qiyang Huang
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China
| | - Kaichun Fan
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China
| | - Yongping Mao
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China
| | - Gang Sun
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China
| | - Yunsheng Yang
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China
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Ramchandani M, Reddy DN, Lakhtakia S, Tandan M, Maydeo A, Chandrashekhar TS, Kumar A, Sud R, Rerknimitr R, Makmun D, Khor C. Per oral cholangiopancreatoscopy in pancreatico biliary diseases--expert consensus statements. World J Gastroenterol 2015; 21:4722-4734. [PMID: 25914484 PMCID: PMC4402322 DOI: 10.3748/wjg.v21.i15.4722] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 11/19/2014] [Accepted: 01/21/2015] [Indexed: 02/06/2023] Open
Abstract
AIM To provide consensus statements on the use of per-oral cholangiopancreatoscopy (POCPS). METHODS A workgroup of experts in endoscopic retrograde cholangiopancreatography (ERCP), endosonography, and POCPS generated consensus statements summarizing the utility of POCPS in pancreaticobiliary disease. Recommendation grades used validated evidence ratings of publications from an extensive literature review. RESULTS Six consensus statements were generated: (1) POCPS is now an important additional tool during ERCP; (2) in patients with indeterminate biliary strictures, POCS and POCS-guided targeted biopsy are useful for establishing a definitive diagnosis; (3) POCS and POCS-guided lithotripsy are recommended for treatment of difficult common bile duct stones when standard techniques fail; (4) in patients with main duct intraductal papillary mucinous neoplasms (IPMN) POPS may be used to assess extent of tumor to assist surgical resection; (5) in difficult pancreatic ductal stones, POPS-guided lithotripsy may be useful in fragmentation and extraction of stones; and (6) additional indications for POCPS include selective guidewire placement, unexplained hemobilia, assessing intraductal biliary ablation therapy, and extracting migrated stents. CONCLUSION POCPS is important in association with ERCP, particularly for diagnosis of indeterminate biliary strictures and for intra-ductal lithotripsy when other techniques failed, and may be useful for pre-operative assessment of extent of main duct IPMN, for extraction of difficult pancreatic stones, and for unusual indications involving selective guidewire placement, assessing unexplained hemobilia or intraductal biliary ablation therapy, and extracting migrated stents.
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Kawakami H, Itoi T, Kuwatani M, Kawakubo K, Kubota Y, Sakamoto N. Technical tips and troubleshooting of endoscopic biliary drainage for unresectable malignant hilar biliary obstruction. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2015; 22:E12-E21. [PMID: 25379788 DOI: 10.1002/jhbp.186] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Unresectable malignant hilar biliary obstruction (MHBO) occurs in various diseases, such as cholangiocarcinoma, gallbladder carcinoma, hepatocellular carcinoma, pancreatic cancer, and lymph node metastasis of the hilum of the liver. The majority of patients with advanced MHBO are not candidates for surgical resection because of the tumor location in the hepatic hilum and adjacent areas, advanced tumor stage, or comorbidities. Therefore, these patients often have a poor prognosis in terms of survival and quality of life. Most of these patients will require non-surgical, palliative biliary drainage. To date, various biliary drainage techniques for unresectable MHBO (UMHBO) have been reported. Of these techniques, endoscopic biliary drainage is currently considered to be the most safe and minimally invasive procedure. However, endoscopic biliary drainage for UMHBO is still not standardized regarding the optimal stent, drainage area, stenting method, and reintervention technique. Recently, towards standardization of this technique for UMHBO, clinical research and trials including randomized controlled trials have been performed. In this article, we reviewed the most important issues regarding endoscopic biliary drainage for UMHBO, focusing on prospective studies. We also described in detail the techniques and future perspectives of endoscopic biliary drainage in patients with UMHBO.
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Affiliation(s)
- Hiroshi Kawakami
- Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Kita 14, Nishi 5, Kita-ku, Sapporo, 060-8648, Japan.
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Tsuchikawa T, Hirano S, Okamura K, Matsumoto J, Tamoto E, Murakami S, Nakamura T, Ebihara Y, Kurashima Y, Shichinohe T. Advances in the surgical treatment of hilar cholangiocarcinoma. Expert Rev Gastroenterol Hepatol 2015; 9:369-74. [PMID: 25256146 DOI: 10.1586/17474124.2015.960393] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
With the improvement of perioperative management and surgical techniques as well as the accumulation of knowledge on the oncobiological behavior of bile duct carcinoma, the long-term prognosis of hilar cholangiocarcinoma has been improving. In this article, the authors review the recent developments in surgical strategies for hilar cholangiocarcinoma, focusing on diagnosis for characteristic disease extension, perioperative management to reduce postoperative morbidity and mortality, surgical techniques for extended curative resection and postoperative adjuvant therapy.
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Affiliation(s)
- Takahiro Tsuchikawa
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, N-15 W-7, Sapporo 060-8638, Japan
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Kawakubo K, Kawakami H, Kuwatani M, Kudo T, Abe Y, Kawahata S, Kubo K, Kubota Y, Sakamoto N. Single-step simultaneous side-by-side placement of a self-expandable metallic stent with a 6-Fr delivery system for unresectable malignant hilar biliary obstruction: a feasibility study. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2015; 22:151-155. [PMID: 25345586 DOI: 10.1002/jhbp.173] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Bilateral self-expandable metallic stent (SEMS) placement for the management of unresectable malignant hilar biliary obstruction (UMHBO) is technically challenging to perform using the existing metallic stents with thick delivery systems. The recently developed 6-Fr delivery systems could facilitate a single-step simultaneous side-by-side placement through the accessory channel of the duodenoscope. The aim of this study was to evaluate the feasibility of this procedure. METHODS Between May and September 2013, 13 consecutive patients with UMHBO underwent a single-step simultaneous side-by-side placement of SEMS with the 6-Fr delivery system. The technical success rate, stent patency, and rate of complications were evaluated from the prospectively collected database. RESULTS Technical success was achieved in 11 (84.6%, 95% confidence interval [CI]: 57.8-95.8) patients. The median procedure time was 25 min. Early and late complications were observed in 23% (one segmental cholangitis and two liver abscesses) and 15% (one segmental cholangitis and one cholecystitis) patients, respectively. Median dysfunction free patency was 263 days (95% CI: 37-263). Five patients (38%) experienced stent occlusion that was successfully managed by endoscopic stent placement. CONCLUSIONS A single-step simultaneous side-by-side placement of SEMS with a 6-Fr delivery system was feasible for the management of UMHBO.
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Affiliation(s)
- Kazumichi Kawakubo
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
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Kawakubo K, Kawakami H, Toyokawa Y, Otani K, Kuwatani M, Abe Y, Kawahata S, Kubo K, Kubota Y, Sakamoto N. Risk factors for technical failure of endoscopic double self-expandable metallic stent placement by partial stent-in-stent method. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2015; 22:79-85. [PMID: 25308061 DOI: 10.1002/jhbp.170] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Endoscopic double self-expandable metallic stent (SEMS) placement by the partial stent-in-stent (PSIS) method has been reported to be useful for the management of unresectable hilar malignant biliary obstruction. However, it is technically challenging, and the optimal SEMS for the procedure remains unknown. The aim of this study was to identify the risk factors for technical failure of endoscopic double SEMS placement for unresectable malignant hilar biliary obstruction (MHBO). METHODS Between December 2009 and May 2013, 50 consecutive patients with MHBO underwent endoscopic double SEMS placement by the PSIS method. We retrospectively evaluated the rate of successful double SEMS placement and identified the risk factors for technical failure. RESULTS The technical success rate for double SEMS placement was 82.0% (95% confidence interval [CI]: 69.2-90.2). On univariate analysis, the rate of technical failure was high in patients with metastatic disease and unilateral placement. Multivariate analysis revealed that metastatic disease was a significant risk factor for technical failure (odds ratio: 9.63, 95% CI: 1.11-105.5). The subgroup analysis after double guidewire insertion showed that the rate of technical success was higher in the laser-cut type SEMS with a large mesh and thick delivery system than in the braided type SEMS with a small mesh and thick delivery system. CONCLUSIONS Metastatic disease was a significant risk factor for technical failure of double SEMS placement for unresectable MHBO. The laser-cut type SEMS with a large mesh and thin delivery system might be preferable for the PSIS procedure.
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Affiliation(s)
- Kazumichi Kawakubo
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
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A novel technique for endoscopic transpapillary "mapping biopsy specimens" of superficial intraductal spread of bile duct carcinoma (with videos). Gastrointest Endosc 2014; 79:1020-5. [PMID: 24674353 DOI: 10.1016/j.gie.2014.01.040] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 01/22/2014] [Indexed: 01/03/2023]
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Nishikawa T, Tsuyuguchi T, Sakai Y, Sugiyama H, Kishimoto T, Ohtsuka M, Miyazaki M, Yokosuka O. Preoperative assessment of longitudinal extension of cholangiocarcinoma with peroral video-cholangioscopy: a prospective study. Dig Endosc 2014; 26:450-7. [PMID: 23981193 DOI: 10.1111/den.12159] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 07/17/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Preoperative assessment of longitudinal extension of cholangiocarcinoma (CCA) is essential for making decisions concerning surgical resection and selecting operative procedures. We evaluated the accuracy of peroral video-cholangioscopy (PVCS) in diagnosing longitudinal extension of CCA. METHODS Patients with CCA who underwent preoperative PVCS were considered for this study. We evaluated the accuracy of PVCS in diagnosing longitudinal extension of perihilar cholangiocarcinoma (PCCA) and distal extrahepatic cholangiocarcinoma (DCCA) to the secondary biliary radicles and confluence of the hepatic ducts, respectively, on the hepatic side and to the intrapancreatic common bile duct on the papillary side. Diagnostic accuracy was determined by comparing the results with those of histopathological analyses of surgical specimens. RESULTS Forty-three consecutive patients were enrolled. The cholangioscope could not be advanced into the hepatic side in eight of the 25 patients with PCCA and in five of the 18 patients with DCCA. The accuracy of PVCS in diagnosing longitudinal extension of CCA on the hepatic and papillary sides was 82.4% and 92.0%, respectively, in patients with PCCA and 92.3% and 100%, respectively, in patients with DCCA. PVCS accurately detected longitudinal extension of CCA to the hepatic and papillary sides that was not detected previously by endoscopic retrograde cholangiography in 20.0% and 11.6% patients, respectively. CONCLUSIONS PVCS proved useful for the preoperative assessment of longitudinal extension of CCA. Therefore, it can aid surgeons in deciding surgical resectability and selecting operative procedures. This, in turn, may impact overall patient prognosis.
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Affiliation(s)
- Takao Nishikawa
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Hirano S, Tanaka E, Tsuchikawa T, Matsumoto J, Kawakami H, Nakamura T, Kurashima Y, Ebihara Y, Shichinohe T. Oncological benefit of preoperative endoscopic biliary drainage in patients with hilar cholangiocarcinoma. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2014; 21:533-40. [PMID: 24464984 DOI: 10.1002/jhbp.76] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Due to advances in endoscopic equipment and techniques, preoperative endoscopic biliary drainage (EBD) has been developed to serve as an alternative to percutaneous transhepatic biliary drainage (PTBD). This study sought to clarify the benefit of EBD in comparison to PTBD in patients who underwent radical resections of hilar cholangiocarcinoma. One hundred and forty-one patients underwent radical surgery for hilar cholangiocarcinoma between 2000 and 2008 were retrospectively divided into two groups based on the type of preoperative biliary drainage, PTBD (n = 67) or EBD (n = 74). We investigated if the different biliary drainage methods affected postoperative survival and mode of recurrence after median observation period of 82 months. The survival rate for patients who underwent EBD was significantly higher than those who had PTBD (P = 0.004). Multivariate analysis revealed that PTBD was one of the independent factors predictive of poor survival (hazard ratio: 2.075, P = 0.003). Patients with PTBD more frequently developed peritoneal seeding in comparison to those who underwent EBD (P = 0.0003). PTBD was the only independent factor predictive of peritoneal seeding. In conclusion, EBD might confer an improved prognosis over PTBD due to prevention of peritoneal seeding, and is recommended as the initial procedure for preoperative biliary drainage in patients with hilar cholangiocarcinoma.
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Affiliation(s)
- Satoshi Hirano
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.
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Sano T, Shimizu Y, Senda Y, Komori K, Ito S, Abe T, Kinoshita T, Nimura Y. Isolated caudate lobectomy with pancreatoduodenectomy for a bile duct cancer. Langenbecks Arch Surg 2013; 398:1145-50. [PMID: 24026222 DOI: 10.1007/s00423-013-1110-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 08/23/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND In patients with distal bile duct cancer involving the hepatic hilus, a major hepatectomy concomitant with pancreatoduodenectomy (HPD) is sometimes ideal to obtain a cancer-free resection margin. However, the surgical invasiveness of HPD is considerable. PATIENTS AND METHODS We present our treatment option for patients with distal bile duct cancer showing mucosal spreading to the hepatic hilum associated with impaired liver function. To minimize resection volume of the liver, an isolated caudate lobectomy (CL) with pancreatoduodenectomy (PD) using an anterior liver splitting approach is presented. Liver transection lines and bile duct resection points correspond complete with our standard right and left hemihepatectomies with CL for perihilar cholangiocarcinoma. RESULTS Total operation time was 765 min, and pedicle occlusion time was 124 min, respectively. Although the proximal mucosal cancer extension was identified at both the right and the left hepatic ducts, all resection margins were negative for cancer. CONCLUSIONS Isolated CL with PD is an alternative radical treatment option for bile duct cancer patients with impaired liver function.
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Affiliation(s)
- Tsuyoshi Sano
- Hepatobiliary and Pancreatic Surgery Division, Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan,
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Gabbert C, Warndorf M, Easler J, Chennat J. Advanced techniques for endoscopic biliary imaging: cholangioscopy, endoscopic ultrasonography, confocal, and beyond. Gastrointest Endosc Clin N Am 2013; 23:625-46. [PMID: 23735107 DOI: 10.1016/j.giec.2013.03.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Cholangioscopy, endosonography, and confocal microscopy represent important technologies that expand biliary imaging beyond a level previously realized by noninvasive modalities (ultrasonography, computed tomography, and magnetic resonance cholangiopancreatography) and endoscopic retrograde cholangiopancreatography. Endoscopic ultrasonography has shown efficacy for the evaluation of indeterminate biliary strictures; however, this modality seems most reliable for distal bile duct abnormalities and in the setting of a moderate to high pretest probability for malignancy. Further refinement of these technologies, validation of their respective diagnostic criteria, and study within the context of comparative, randomized trials are needed and will contribute greatly to expedient patient care.
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Affiliation(s)
- Charles Gabbert
- Division of Gastroenterology, Hepatology, & Nutrition, University of Pittsburgh Medical Center, 200 Lothrop Street, C Wing, Mezzanine Level, Pittsburgh, PA 15213, USA
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Potential role of peroral cholangioscopy for preoperative diagnosis of cholangiocarcinoma. Surg Laparosc Endosc Percutan Tech 2013; 22:532-6. [PMID: 23238382 DOI: 10.1097/sle.0b013e3182686178] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND/PURPOSE We evaluated the utility of peroral cholangioscopy (POCS) for preoperative diagnosis of cholangiocarcinoma. METHODS POCS was performed to assess the horizontal extension of the carcinoma. We compared the results of assessment with those of histologic analysis of 44 surgically resected specimens. RESULTS Cholangiocarcinoma types were described as filling defects and strictures in 16 and 28 patients, respectively, using cholangiography. Endoscopic retrograde cholangiography (ERC) identified tumor extension in 5 and 15 patients with filling defects (31.25%) and strictures (53.57%), respectively. ERC+POCS identified tumor extension in 15 and 16 patients with filling defects (93.75%) and strictures (60.71%), respectively. ERC+POCS was significantly useful for patients with filling defects compared with ERC alone (P=0.002). ERC+POCS was not significantly useful for patients with strictures compared with ERC alone. CONCLUSIONS POCS is a useful preoperative examination modality for assessing tumor extension in cholangiocarcinoma patients, especially in those with filling defects.
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