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Digital Pancreaticocholangioscopy for Mapping of Pancreaticobiliary Neoplasia

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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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Keywords: SpyGlass; biliary duct; cholangioscopy; mapping; pancreatic duct; pancreaticocholangioscopy; pancreatoscopy; surgery

Document Type: Research Article

Affiliations: 1: Weill Cornell Medical Center 2: Department of Gastroenterology, Houston Medical Center, Houston 3: Department of Gastroenterology, Thomas Jefferson University, Philadelphia, PA 4: Department of Gastroenterology, Karolinska Institut, Stockholm, Sweden 5: Department of Gastroenterology, University of Utah, Salt Lake City, UT 6: Department of Gastroenterology, Staten Island University Hospital, Staten Island 7: Department of Gastroenterology, North Shore LIJ, Long Island 8: Department of Gastroenterology, Methodist, Dallas, TX 9: Department of Gastroenterology, SoonChunHyang University School of Medicine, Seoul, Republic of Korea 10: Department of Gastroenterology, CUMC, New York 11: Department of Gastroenterology, Montefiore Medical Center, Bronx, NY

Publication date: January 1, 2019

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