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

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

Research output: Contribution to journalArticle

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.

LanguageEnglish (US)
Pages71-75
Number of pages5
JournalJournal of Clinical Gastroenterology
Volume53
Issue number1
DOIs
StatePublished - Jan 1 2019

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Neoplasms
Endoscopic Retrograde Cholangiopancreatography
Pancreatic Ducts
Bile Ducts
Margins of Excision
Histology
Pancreatitis
Endoscopy
Patient Care
Prospective Studies

Keywords

  • biliary duct
  • cholangioscopy
  • mapping
  • pancreatic duct
  • pancreaticocholangioscopy
  • pancreatoscopy
  • SpyGlass
  • surgery

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Digital Pancreaticocholangioscopy for Mapping of Pancreaticobiliary Neoplasia : Can We Alter the Surgical Resection Margin? / Tyberg, Amy; Raijman, Isaac; Siddiqui, Ali; Arnelo, Urban; Adler, Douglas G.; Xu, Ming Ming; Nassani, Najib; Sejpal, DIvyesh V.; Kedia, Prashant; Nah Lee, Yun; Gress, Frank G.; Ho, Sammy; Gaidhane, Monica; Kahaleh, Michel.

In: Journal of Clinical Gastroenterology, Vol. 53, No. 1, 01.01.2019, p. 71-75.

Research output: Contribution to journalArticle

Tyberg, A, Raijman, I, Siddiqui, A, Arnelo, U, Adler, DG, Xu, MM, Nassani, N, Sejpal, DIV, Kedia, P, Nah Lee, Y, Gress, FG, Ho, S, Gaidhane, M & Kahaleh, M 2019, 'Digital Pancreaticocholangioscopy for Mapping of Pancreaticobiliary Neoplasia: Can We Alter the Surgical Resection Margin?', Journal of Clinical Gastroenterology, vol. 53, no. 1, pp. 71-75. https://doi.org/10.1097/MCG.0000000000001008
Tyberg, Amy ; Raijman, Isaac ; Siddiqui, Ali ; Arnelo, Urban ; Adler, Douglas G. ; Xu, Ming Ming ; Nassani, Najib ; Sejpal, DIvyesh V. ; Kedia, Prashant ; Nah Lee, Yun ; Gress, Frank G. ; Ho, Sammy ; Gaidhane, Monica ; Kahaleh, Michel. / Digital Pancreaticocholangioscopy for Mapping of Pancreaticobiliary Neoplasia : Can We Alter the Surgical Resection Margin?. In: Journal of Clinical Gastroenterology. 2019 ; Vol. 53, No. 1. pp. 71-75.
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AU - Kedia, Prashant

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N2 - 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.

AB - 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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