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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Sep 16, 2022; 14(9): 536-546
Published online Sep 16, 2022. doi: 10.4253/wjge.v14.i9.536
Screening for hilar biliary invasion in ampullary cancer patients
Tadayuki Takagi, Mitsuru Sugimoto, Rei Suzuki, Naoki Konno, Hiroyuki Asama, Yuki Sato, Hiroki Irie, Jun Nakamura, Mika Takasumi, Minami Hashimoto, Tsunetaka Kato, Ryoichiro Kobashi, Takumi Yanagita, Yuko Hashimoto, Shigeru Marubashi, Takuto Hikichi, Hiromasa Ohira
Tadayuki Takagi, Mitsuru Sugimoto, Rei Suzuki, Naoki Konno, Hiroyuki Asama, Yuki Sato, Hiroki Irie, Mika Takasumi, Takumi Yanagita, Hiromasa Ohira, Department of Gastroenterology, Fukushima Medical University, Fukushima 960-1295, Japan
Jun Nakamura, Minami Hashimoto, Tsunetaka Kato, Ryoichiro Kobashi, Takuto Hikichi, Department of Endoscopy, Fukushima Medical University Hospital, Fukushima 960-1295, Japan
Yuko Hashimoto, Department of Pathological Diagnosis, Fukushima Medical University, Fukushima 960-1295, Japan
Shigeru Marubashi, Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Fukushima 960-1295, Japan
Author contributions: Takagi T and Sugimoto M wrote the paper and designed and performed the study; Ohira H designed and oversaw the study; Suzuki R, Konno N, Asama H, Hikichi T, Nakamura J, Takasumi M, Sato Y, Irie H, Hashimoto M, Kato T, Kobashi R, and Yanagita T provided clinical advice; Hashimoto Y performed pathological diagnoses, and all authors read and approved the final version of the manuscript.
Institutional review board statement: This study was approved by the Institutional Review Board of Fukushima Medical University (approval number: 2453).
Informed consent statement: The patients were not required to give informed consent because this study “Screening for Hilar Biliary Invasion in Ampullary Cancer Patients” used anonymous clinical data obtained after each patient had agreed to medical activities by written consent. For full disclosure, the details of this study are published on the home page of Fukushima Medical University.
Conflict-of-interest statement: All authors declare that they have no competing interests.
Data sharing statement: The datasets analyzed during the current study are available from the corresponding author upon reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Mitsuru Sugimoto, MD, PhD, Assistant Professor, Department of Gastroenterology, Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan.
kitachuuou335@yahoo.co.jp
Received: January 5, 2022
Peer-review started: January 5, 2022
First decision: June 16, 2022
Revised: June 28, 2022
Accepted: August 7, 2022
Article in press: August 7, 2022
Published online: September 16, 2022
Processing time: 252 Days and 18.5 Hours
ARTICLE HIGHLIGHTS
Research background
The standard treatment for ampullary cancer is pancreaticoduodenectomy or focal ampullectomy. Before resection, it is important to accurately diagnose the biliary invasion of ampullary cancer. However, the method that accurately evaluates hilar invasion of ampullary cancer is unknown.
Research motivation
Several methods [contrast-enhanced computed tomography (CECT), endoscopic retrograde cholangiography (ERC), intraductal ultrasonography (IDUS), biliary biopsy] can be used to diagnose the range of ampullary cancer invasion. However, detailed data of these methods for diagnosing the biliary invasion range of ampullary cancer have not been previously reported. Therefore, presurgical examination is not established in ampullary cancer patients.
Research objectives
To reveal the necessity of hilar investigation in ampullary cancer and a useful method for diagnosing whether ampullary cancer invades the hilar biliary duct.
Research methods
Diagnosability was compared between CECT, ERC, IDUS, and biliary biopsy in ampullary cancer patients who underwent pancreaticoduodenectomy or focal ampullectomy.
Research results
The combination of biliary biopsy results and partial thickening of the bile duct wall on IDUS was efficient for diagnosing hilar invasion of ampullary cancer.
Research conclusions
Although false positives were observed for each method, hilar invasion was appropriately diagnosed based on the combination of biliary biopsy results and partial thickening of the bile duct wall on IDUS. However, hilar biliary invasion is rare in ampullary cancer. Therefore, hilar investigation might be unnecessary for ampullary cancer patients.
Research perspectives
The results of this study contribute to the establishment of a systematic method for diagnosing hilar invasion and selecting treatments for ampullary cancer patients.
