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Digital Pancreaticocholangioscopy for Mapping of Pancreaticobiliary Neoplasia Can We Alter the Surgical Resection Margin?

Authors
Tyberg, AmyRaijman, IsaacSiddiqui, AliArnelo, UrbanAdler, Douglas G.Xu, Ming-mingNassani, NajibSejpal, Divyesh V.Kedia, PrashantLee, Yun NahGress, Frank G.Ho, SammyGaidhane, MonicaKahaleh, Michel
Issue Date
Jan-2019
Publisher
Lippincott Williams & Wilkins Ltd.
Keywords
SpyGlass; pancreaticocholangioscopy; cholangioscopy; pancreatoscopy; biliary duct; pancreatic duct; mapping; surgery
Citation
Journal of Clinical Gastroenterology, v.53, no.1, pp 71 - 75
Pages
5
Journal Title
Journal of Clinical Gastroenterology
Volume
53
Number
1
Start Page
71
End Page
75
URI
https://scholarworks.bwise.kr/sch/handle/2021.sw.sch/4838
DOI
10.1097/MCG.0000000000001008
ISSN
0192-0790
1539-2031
Abstract
Introduction: In patients with pancreaticobiliary lesions anticipating surgical resection, digital pancreaticocholangioscopy can be used to identify the extent of disease. This presurgical"mapping" could change the surgical plan and optimize patient care. Materials and Methods: Patients with pancreaticobiliary lesions anticipating surgery who underwent endoscopic retrograde cholangiopancreatography with digital pancreaticocholangioscopy from 9 international centers were included. Primary outcome was whether pancreaticocholangioscopy altered the surgical plan. Secondary outcome was correlation between surgical and endoscopic histology and adverse events. Results: A total of 118 patients were included (64% male, mean age 69 y): cholangioscopy in 105 patients (89%), pancreatoscopy in 13 patients (11%). Pancreaticocholangioscopy changed the surgical plan in 39 (34%) of patients: 8 of 13 in the pancreatic duct, 32 of 105 in the bile duct. In the bile duct, 6 patients (5%) had less extensive surgery, 26 patients (25%) avoided surgery. In the pancreatic duct, 4 patients (31%) had more extensive surgery and 4 patients (31%) had less extensive surgery. Four patients with downstaged surgery had positive margins on surgical resection; 1 required additional surgical intervention. Overall correlation between endoscopy and surgical histology was 88%. Adverse events included post endoscopic retrograde cholangiopancreatography pancreatitis in 3 patients (2.5%). Conclusion: Digital pancreaticocholangioscopy can be effectively used as a mapping tool to delineate the degree of involvement of biliary lesions before surgical resection, in some cases altering the surgical plan. Prospective studies are needed, especially when downstaging surgery.
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