Preoperative assessment of longitudinal extension of cholangiocarcinoma with peroral video‐cholangioscopy: A prospective study

Abstract

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.

Can image-enhanced cholangioscopy distinguish benign from malignant lesions in the biliary duct?

“…reported that NBI did not improve the diagnostic accuracy of POCS, because the light volume in NBI is very small for observation of a distant target, or WLI is sufficient for the identification of biliary mucosal change [10,46].…”

“…Therefore, this morphological feature may enable the differentiation between benign and malignant lesions, not only detecting abnormal mucosal vessels but also paying attention to the morphology of the mucosal vessels. Many studies revealed the good diagnostic yield of POCS using NBI; however, these studies evaluated rigorous endoscopic findings as described in Table 2 (Fig.5, 6,7,8,9,10,11,12) [8][9][10]. Because an irregular mucosa including a scale-like appearance was also identified in an inflammatory non-neoplastic mucosa (Fig.11, 12)[7], it is also important not only to detect "irregular surface" but also to observe detailed surface structure.…”

“…It is also possible to apply the image-enhanced function called the narrow-band imaging (NBI) system to POCS [5,6]. Although there have been a number of case studies describing the diagnostic yield of the new video POCS (Table 1) [7][8][9][10], POCS has not been commonly used because of major issues involving its challenging maneuverability and fragility [3]. To overcome these issues and to equip the POCS system with a larger operating channel, direct peroral cholangioscopy (D-POCS) has been reported with some insertion techniques [11][12][13][14].…”

Comprehensive management of cholangiocarcinoma: Part I. Diagnosis

“…POCS improved the overall accuracy of ERCP in assessing longitudinal extension of tumor by 20% on the hepatic side and 12% on the papillary side. 95 To enhance the diagnostic yield of POCS, chromo-cholangioscopy with methylene blue staining of the duct wall and POCS with narrow band imaging have been reported. It is known that CC cells do not stain or stain minimally for methylene blue.…”

Effect of mapping biopsy on surgical management of cholangiocarcinoma

“…CCA spreads by longitudinal intraductal extension, direct invasion to the surrounding vessels/organs, hematogenous metastasis, or lymphatic metastasis. Assessment of longitudinal extension is essential for making decisions concerning surgical resection and selecting surgical procedures …”