Digital Pancreaticocholangioscopy for Mapping of Pancreaticobiliary Neoplasia

Tyberg, Amy; Raijman, Isaac; Siddiqui, Ali A.; Arnelo, Urban; Adler, Douglas G.; Xu, Ming; Nassani, Najib; Sejpal, Divyesh V.; Kedia, Prashant; Lee, Yun Nah; Gress, Frank G.; Ho, Sammy; Gaidhane, Monica; Kahaleh, Michel

doi:10.1097/mcg.0000000000001008

Cited by 38 publications

(26 citation statements)

References 21 publications

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“…The decision to perform resection should only be considered after careful evaluation of multiple aspects related to the general conditions and the expectancy of life of a patient. In conjunction with new biomarkers or diagnostic modalities such as pancreatoscopy [ 61 , 62 ], MPD dilatation detection could improve surgical patient selection and reduce overall IPMN malignancy mortality.…”

Section: Discussionmentioning

confidence: 99%

Ductal Dilatation of ≥5 mm in Intraductal Papillary Mucinous Neoplasm Should Trigger the Consideration for Pancreatectomy: A Meta-Analysis and Systematic Review of Resected Cases

Oba

Beaty

et al. 2021

Cancers

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Intraductal papillary mucinous neoplasms (IPMN) are common but difficult to manage since accurate tools for diagnosing malignancy are unavailable. This study tests the diagnostic value of the main pancreatic duct (MPD) diameter for detecting IPMN malignancy using a meta-analysis of published data of resected IPMNs. Collected from a comprehensive literature search, the articles included in this analysis must report malignancy cases (high-grade dysplasia (HGD) and invasive carcinoma (IC)) and MPD diameter so that two MPD cut-offs could be created. The sensitivity, specificity, and odds ratios of the two cutoffs for predicting malignancy were calculated. A review of 1493 articles yielded 20 retrospective studies with 3982 resected cases. A cutoff of ≥5 mm is more sensitive than the ≥10 mm cutoff and has pooled sensitivity of 72.20% and 75.60% for classification of HGD and IC, respectively. Both MPD cutoffs of ≥5 mm and ≥10 mm were associated with malignancy (OR = 4.36 (95% CI: 2.82, 6.75) vs. OR = 3.18 (95% CI: 2.25, 4.49), respectively). The odds of HGD and IC for patients with MPD ≥5 mm were 5.66 (95% CI: 3.02, 10.62) and 7.40 (95% CI: 4.95, 11.06), respectively. OR of HGD and IC for MPD ≥10 mm cutoff were 4.36 (95% CI: 3.20, 5.93) and 4.75 (95% CI: 2.39, 9.45), respectively. IPMN with MPD of >5 mm could very likely be malignant. In selected IPMN patients, pancreatectomy should be considered when MPD is >5 mm.

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Section: Discussionmentioning

confidence: 99%

Ductal Dilatation of ≥5 mm in Intraductal Papillary Mucinous Neoplasm Should Trigger the Consideration for Pancreatectomy: A Meta-Analysis and Systematic Review of Resected Cases

Oba

Beaty

et al. 2021

Cancers

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“…Five of these eight patients underwent modified surgery, with 90.5% disease-free survival at a mean of 93 mo. Tyberg et al[46] outlined the role of POP in guiding surgical therapy for lesions in the PD. Out of 13 patients who underwent POP, the initial surgical plan was altered in eight (62%), with an overall correlation of 88% between pancreatoscopy and final surgical histology.…”

Section: Discussionmentioning

confidence: 99%

Role of pancreatoscopy in management of pancreatic disease: A systematic review

Kaura

Willingham

Chawla

2019

WJGE

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BACKGROUNDPer-oral pancreatoscopy (POP) plays a role in the diagnosis and therapy of pancreatic diseases. With recent technological advances, there has been renewed interest in this modality.AIMTo evaluate the efficacy and safety of POP in management of pancreatic stone disease and pancreatic ductal neoplasia.METHODSTo determine the safety and efficacy of POP in the management of pancreatic diseases, a systematic search was conducted in MEDLINE, EMBASE and Ovid. Articles in languages other than English and case reports were excluded. All published case series were eligible. Data specific to POP were extracted from studies, which combined cholangiopancreatoscopy. Ten studies were included in the analysis of POP therapy for pancreatic stone disease, and 15 case series satisfied the criteria for inclusion for the role of POP in the management of pancreatic ductal neoplasia. The examined data were subcategorized according to adjunctive modalities, such as direct tissue sampling, cytology, the role of intraoperative POP, intraductal ultrasound (IDUS) and POP combined with image-enhancing technology.RESULTSThe success rate for complete ductal stone clearance ranged from 37.5%-100%. Factors associated with failure included the presence of strictures, multiple stones and the inability to visualize the target area. Although direct visualization can identify malignant and premalignant conditions, there is significant overlap with benign diseases. Visually-directed biopsies provide a high degree of accuracy, and represent a unique approach for tissue acquisition in patients with ductal abnormalities. Addition of pancreatic fluid cytology increases diagnostic yield for indeterminate lesions. Protrusions larger than 3 mm noted on IDUS are significantly more likely to be associated with malignancy. The rate of adverse events associated with POP ranged from 0%-35%.CONCLUSIONCurrent evidence supports wider adoption of pancreatoscopy, as it is safe and effective. Improved patient selection and utilization of novel technologies may further enhance its role in managing pancreatic disease.

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“…Single operator cholangioscopy-guided mapping biopsy accuracy for preoperative diagnosis was 84% and 100%, respectively for the liver side and the ampullary side. This oriental experience has recently been reproduced in a multicenter study, including various US centers and one European center [40]. In 118 patients with pancreatobiliary lesions, SOC changed the surgical plan in 32 patients with biliary lesions; 6 (5%) had less extensive surgery and 26 (25%) avoided surgery.…”

Section: Mapping Of Intraductal Cholangiocarcinoma Prior To Resectionmentioning

confidence: 99%

Cholangiopancreatoscopy: Expanding the Diagnostic Indications of Endoscopic Retrograde Cholangiopancreatography

Pereira

Costa-Moreira

Macedo

2020

JGLD

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Besides the adverse effects associated with endoscopic retrograde cholangiopancreatography (ERCP), indirect visualization of the biliopancreatic system through fluoroscopy has limited its diagnostic and therapeutic efficacy. Direct visualization through cholangiopancreatoscopy may overcome this limitation and allow the resolution of many dilemmas related to the diagnostic and therapeutic drawbacks of ERCP. Herein, we discuss the current indications of single-operator cholangioscopy (SOC) concerning the diagnostic interventions within the biliopancreatic system. The current role of SOC in the diagnosis of pancreatobiliary stenosis, primary sclerosing cholangitis, intraductal papillary mucinous neoplasm, and pre-surgical mapping of neoplastic lesions were reviewed. There is growing data in the literature supporting the early implementation of SOC in the diagnostic algorithm of pancreatobiliary diseases. In selected cases, this could prevent diagnostic delay and reduce the risks and costs related to repeated ERCPs. This potential characterizes SOC as safety and cost-effective.

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Digital Pancreaticocholangioscopy for Mapping of Pancreaticobiliary Neoplasia

Abstract: Digital pancreaticocholangioscopy can be effectively used as a mapping tool to delineate the degree of involvement of biliary lesions before surgical resection, in some cases altering the surgical plan. Prospective studies are needed, especially when downstaging surgery.

Cited by 38 publications

References 21 publications

Ductal Dilatation of ≥5 mm in Intraductal Papillary Mucinous Neoplasm Should Trigger the Consideration for Pancreatectomy: A Meta-Analysis and Systematic Review of Resected Cases

Ductal Dilatation of ≥5 mm in Intraductal Papillary Mucinous Neoplasm Should Trigger the Consideration for Pancreatectomy: A Meta-Analysis and Systematic Review of Resected Cases

Role of pancreatoscopy in management of pancreatic disease: A systematic review

Cholangiopancreatoscopy: Expanding the Diagnostic Indications of Endoscopic Retrograde Cholangiopancreatography

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