Preoperative assessment of longitudinal extension of cholangiocarcinoma with peroral video-cholangioscopy: a prospective study.

Abstract

BACKGROUND AND AIM:

Preoperative assessment of longitudinal extension of cholangiocarcinoma (CCA) is essential for making decisions concerning surgical resection and selecting operative procedures. We evaluated the accuracy of peroral video-cholangioscopy (PVCS) in diagnosing longitudinal extension of CCA.

METHODS:

Patients with CCA who underwent preoperative PVCS were considered for this study. We evaluated the accuracy of PVCS in diagnosing longitudinal extension of perihilar cholangiocarcinoma (PCCA) and distal extrahepatic cholangiocarcinoma (DCCA) to the secondary biliary radicles and confluence of the hepatic ducts, respectively, on the hepatic side and to the intrapancreatic common bile duct on the papillary side. Diagnostic accuracy was determined by comparing the results with those of histopathological analyses of surgical specimens.

RESULTS:

Forty-three consecutive patients were enrolled. The cholangioscope could not be advanced into the hepatic side in eight of the 25 patients with PCCA and in five of the 18 patients with DCCA. The accuracy of PVCS in diagnosing longitudinal extension of CCA on the hepatic and papillary sides was 82.4% and 92.0%, respectively, in patients with PCCA and 92.3% and 100%, respectively, in patients with DCCA. PVCS accurately detected longitudinal extension of CCA to the hepatic and papillary sides that was not detected previously by endoscopic retrograde cholangiography in 20.0% and 11.6% patients, respectively.

CONCLUSIONS:

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.

• Authors: Takao Nishikawa, Toshio Tsuyuguchi, Yuji Sakai, Harutoshi Sugiyama, Takashi Kishimoto, Masayuki Ohtsuka, Masaru Miyazaki, Osamu Yokosuka
• Journal: Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society (Dig Endosc) Vol. 26 Issue 3 Pg. 450-7 (May 2014) ISSN: 1443-1661 [Electronic] Australia
• PMID: 23981193 (Publication Type: Evaluation Study, Journal Article)
• Copyright: © 2013 The Authors. Digestive Endoscopy © 2013 Japan Gastroenterological Endoscopy Society.

Chemical References

• Contrast Media

Topics

• Adult
• Aged
• Aged, 80 and over
• Bile Duct Neoplasms (diagnosis, pathology, surgery)
• Bile Ducts, Intrahepatic
• Biliary Tract Surgical Procedures (methods)
• Cholangiocarcinoma (diagnosis, pathology, surgery)
• Cholangiography (methods)
• Cohort Studies
• Contrast Media
• Endoscopy, Digestive System (methods)
• Female
• Humans
• Magnetic Resonance Imaging (methods)
• Male
• Middle Aged
• Neoplasm Invasiveness (pathology)
• Neoplasm Staging
• Preoperative Care (methods)
• Prospective Studies
• Radiographic Image Enhancement
• Sensitivity and Specificity
• Tomography, X-Ray Computed (methods)
• Video Recording