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Medline ® Abstracts for References 6-17

of 'Cholangioscopy and pancreatoscopy'

6
TI
Cholangiopancreatoscopy.
AU
ASGE Technology Committee, Shah RJ, Adler DG, Conway JD, Diehl DL, Farraye FA, Kantsevoy SV, Kwon R, Mamula P, Rodriguez S, Wong Kee Song LM, Tierney WM
SO
Gastrointest Endosc. 2008;68(3):411.
 
AD
PMID
7
TI
Retrograde biliary ultrathin endoscopy enhances biopsy of stenoses and lithotripsy.
AU
Ponchon T, Chavaillon A, Ayela P, Lambert R
SO
Gastrointest Endosc. 1989;35(4):292.
 
Forceps biopsies of biliary stenoses are difficult to direct under fluoroscopy and for this reason may give spurious results. In addition, fluoroscopy does not prevent the electrohydraulic lithotripsy (EHL) probe from damaging the bile duct wall. Retrograde biliary endoscopy with the ultrathin endoscope (UTE) was tested in 12 patients to guide biopsies and in 6 patients to guide EHL. Results of biopsies were confirmed by surgery or the disease course in each of the 12 patients. Only one stone could not be fragmented and removed because the EHL probe could not be properly placed. The diagnosis of biliary stenosis may be markedly enhanced by using a UTE although at the risk of an endoscopic sphincterotomy and subsequent biliary infection. EHL with UTE is difficult and time consuming but further technical development may make it more practical immediately following sphincterotomy.
AD
INSERM U281, Hôpital E. Herriot, Lyon, France.
PMID
8
TI
Transpapillary cholangioscopy-directed lithotripsy in patients with difficult bile duct stones.
AU
Piraka C, Shah RJ, Awadallah NS, Langer DA, Chen YK
SO
Clin Gastroenterol Hepatol. 2007;5(11):1333.
 
BACKGROUND& AIMS: There are limited prospective data and long-term follow-up on cholangioscopy-directed management of difficult bile duct stones. The study objectives were to evaluate the safety and efficacy of cholangioscopy-directed lithotripsy in patients who had failed standard endoscopic retrograde cholangiopancreatography (ERCP) techniques and to determine the stone recurrence rate.
METHODS: Consecutive patients with biliary stones referred for cholangioscopy after failure of conventional stone therapy were enrolled and followed prospectively.
RESULTS: Between February 2000-October 2004, 32 consecutive patients had cholangioscopy-directed lithotripsy (30 electrohydraulic lithotripsy, 2 mechanical) after a mean of 3.3 (range, 2-14) failed ERCPs. Stones were intrahepatic (N = 8); extrahepatic (N = 18); or both (N = 6). Biliary strictures were present in 20 (63%) patients. Cholangioscopy identified additional stones not seen at ERCP in 9 (28%) patients. A mean of 1.4 lithotripsy sessions achieved complete (N = 26, 81%), partial (N = 5, 16%), or failed (N = 1, 3%) stone clearance. Follow-upwas available in 28 (88%) patients for a mean of 29.2 months (95% confidence interval, 20.3-38.1 months). Stone recurrence occurred in 4 of 22 (18%) patients with complete clearance and follow-up data; 3 had primary sclerosing cholangitis. There were 2 minor periprocedural complications and 1 late complication.
CONCLUSIONS: Cholangioscopy-directed lithotripsy is a safe and effective treatment in patients who have failed standard ERCP stone removal techniques. Stone recurrence is low in patients who had complete stone clearance except in patients with primary sclerosing cholangitis. Cholangioscopy detects stones missed by cholangiography.
AD
Division of Gastroenterology and Hepatology, University of Michigan Health System, Ann Arbor, Michigan, USA.
PMID
9
TI
Electrohydraulic lithotripsy in 111 patients: a safe and effective therapy for difficult bile duct stones.
AU
Arya N, Nelles SE, Haber GB, Kim YI, Kortan PK
SO
Am J Gastroenterol. 2004;99(12):2330.
 
BACKGROUND: Choledocholithiasis and intrahepatic bile duct stones pose a significant health hazard, especially in the elderly. The large stone not removable with conventional endoscopic techniques, can be effectively and safely managed with electrohydraulic lithotripsy (EHL).
METHODS: This study is a retrospective review of consecutive patients at the Wellesley Central Hospital and St. Michael's Hospital, who underwent peroral endoscopic fragmentation of bile duct stones with EHL under direct cholangioscopic control using a "mother-baby" endoscopic system between October 1990 and March 2002.
RESULTS: To date, 111 patients have been analyzed. Of the 111 patients reviewed, 94 patients have had complete records and were included in this study. Mean follow-up was 26.2 months (range 0-80). Prior to EHL, 93 of 94 patients (99%) had endoscopic retrograde cholangiopancreatography (ERCP) and failed standard stone extraction techniques (mean 1.9 ERCPs/patient, range 0-5). Indications for EHL were large stones (81 patients) or a narrow caliber bile duct below a stone of average size (13 patients). Successful fragmentation (61 complete, 28 partial) was achieved in 89 of 93 patients (96%) (1 patient was excluded from analysis due to a broken endoscope). Fragmentation failures were due to targeting problems (2 patients) and hard stones (2 patients). Seventy-six percent of patients required 1 EHL session, 14% required 2 sessions, and 10% required 3 or more. All patients with successful stone fragmentation required post-EHL balloon or basket extraction of fragments. Complications included: cholangitis and/or jaundice (13 patients); mild hemobilia (1 patient); mild post-ERCP pancreatitis (1 patient); biliary leak (1 patient); and bradycardia (1 patient). There were no deaths related to EHL. Final stone clearance was achieved in 85 of 94 patients (90%).
CONCLUSIONS: EHL via peroral endoscopic choledochoscopy is a highly successful and safe technique for use in the management of difficult choledocholithiasis and intrahepatic stones. This study has shown a stone fragmentation rate of 96% (89 of 93 patients), and a final stone clearance rate of 90% (85 of 94 patients).
AD
Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
PMID
10
TI
Cholangioscopy and cholangioscopic forceps biopsy in patients with indeterminate pancreaticobiliary pathology.
AU
Shah RJ, Langer DA, Antillon MR, Chen YK
SO
Clin Gastroenterol Hepatol. 2006;4(2):219.
 
BACKGROUND& AIMS: We report the usefulness of cholangioscopy in patients with indeterminate pancreaticobiliary pathology.
METHODS: A prospective collection of 62 consecutive patients during a period of 2.5 years who were referred to our tertiary referral center for cholangioscopy for indeterminate strictures suspicious for malignancy were included. Tissue sampling followed cholangioscopic visualization. Biopsies were obtained under direct visualization (cholangioscopy-directed) or through the duodenoscope (cholangioscopy-assisted).
RESULTS: Sixty-two patients had 72 examinations. Forty patients had nondiagnostic sampling before cholangioscopy. Indications were stricture (n = 67: 16 primary sclerosing cholangitis, 51 non-primary sclerosing cholangitis), ductal dilation, or intraductal mass (n = 5). Biopsies were not performed in 19 because cholangioscopy did not identify suspicious lesions. Of the remaining 53 procedures, 29 underwent either cholangioscopy-directed or cholangioscopy-assisted biopsy, and 24 had both. Cholangioscopy findings consisted of primary sclerosing cholangitis only (n = 18), benign stricture or inflammatory changes (n = 18), bile duct cancer (n = 14), normal (n = 10), pancreatic cancer (n = 5), and other (n = 7). Fifty-eight patients (94%) had follow-up for a mean of 12.4 months (95% confidence interval, 10.1-14.7). Sixteen of 18 (89%) patients with a final diagnosis of malignancy were detected with cholangioscopy. The 2 missed cancers were intrahepatic cholangiocarcinomas. Overall, sensitivity to detect malignancy by cholangioscopy with and without biopsy was 89%, specificity 96%, positive predictive value 89%, and negative predictive value 96%.
CONCLUSIONS: Cholangioscopy with and without biopsy is highly accurate in diagnosing and excluding pancreaticobiliary malignancy in patients with indeterminate strictures.
AD
Division of Gastroenterology and Hepatology, Department of Medicine, University of Colorado Health Sciences Center, Denver, CO, USA.
PMID
11
TI
Is there a role for cholangioscopy in patients with primary sclerosing cholangitis?
AU
Awadallah NS, Chen YK, Piraka C, Antillon MR, Shah RJ
SO
Am J Gastroenterol. 2006;101(2):284.
 
OBJECTIVES: Assess the role of cholangioscopy in primary sclerosing cholangitis for 1) detection of cholangiocarcinoma using cholangioscopy-assisted biopsy 2) detection of stones not seen on cholangiography 3) stone removal with cholangioscopy-directed lithotripsy.
METHODS: Prospective cohort of consecutive patients referred for cholangioscopy to evaluate dominant strictures or stones. A data collection sheet was employed. Follow-up was by chart review/phone contact. Clinical improvement was defined as resolution of jaundice or>or =50% reduction in pain or cholangitis episodes requiring hospitalization.
RESULTS: 41 patients (30M, 11F) had 60 cholangioscopy procedures (55 per oral, 5 percutaneous). 33/41 (80%) patients underwent 44 tissue sampling events.
HISTOLOGY: positive for extrahepatic cholangiocarcinoma (N = 1), negative/atypical (N = 31), and inadequate (N = 1). Stones were found in 23/41 (56%) patients, of which 7/23 (30%) were missed on cholangiography and detected only by cholangioscopy. 9/23 (39%) underwent cholangioscopy-directed lithotripsy. Stone clearance: complete (N = 10, 7 by cholangioscopy-directed lithotripsy after failed conventional stone extraction); partial (N = 7); and not attempted (N = 6). Median follow-up was 17.0 months (range 1-56). Clinical improvement was achieved in 25/40 (63%). Eight patients have undergone transplant and cholangiocarcinoma was present in the explant of two at 1 and 12 months post-cholangioscopy, respectively.
CONCLUSIONS: This is the first series of patients with primary sclerosing cholangitis undergoing cholangioscopy for the evaluation of dominant strictures and cholangioscopy-directed stone therapy with demonstrable clinical benefits. Stones detected by cholangioscopy were missed by cholangiography in nearly one of three patients. Cholangioscopy-directed lithotripsy may be superior to conventional ERCP for achieving complete stone clearance. Despite the use of cholangioscopy, diagnosis of cholangiocarcinoma remains technically challenging.
AD
Division of Gastroenterology, Department of Internal Medicine, University of Colorado Health Sciences Center, Denver, Colorado, USA.
PMID
12
TI
Diagnostic utility of peroral cholangioscopy for various bile-duct lesions.
AU
Fukuda Y, Tsuyuguchi T, Sakai Y, Tsuchiya S, Saisyo H
SO
Gastrointest Endosc. 2005;62(3):374.
 
BACKGROUND: We evaluated the utility of peroral cholangioscopy (POCS) for distinguishing malignant from benign biliary disease to cover low sensitivity of tissue sampling.
METHODS: From February 1992 to April 2004, all consecutive patients who underwent POCS to confirm the etiology of biliary disorders were included in this study. Brushing cytology or endobiliary forceps biopsy also was performed. We analyzed the diagnostic accuracy of tissue sampling with or without POCS diagnosis.
RESULTS: A total of 97 patients (66 men, 31 women; mean age 64.2 years) were included. The final diagnosis was confirmed by surgical resection in 44, clinical follow-up in 52, and cytologic study of ascitic fluid in one. On the basis of ERCP findings, there were 76 strictures and 21 filling defects. Forceps biopsy was performed in 25 patients, and brush cytology was performed in 68 patients. In the remaining 4 patients (4 filling defects, which were identified as stones by POCS), tissue samplings were not carried out. ERCP/tissue sampling correctly identified 22 of 38 malignant strictures and all 35 benign lesions except in 3 patients with inadequate samples(accuracy, 78.0%; sensitivity, 57.9%; specificity, 100%). The addition of POCS correctly identified all 38 malignant strictures and 33 of 38 benign lesions (accuracy, 93.4%; sensitivity, 100%; specificity, 86.8%). For the 21 filling defects observed by ERCP, POCS correctly diagnosed all 8 malignant diseases and 13 benign lesions.
CONCLUSIONS: The addition of POCS to tissue sampling improves the diagnostic ability and covers for insufficient sensitivity. POCS is especially useful for diagnosing a filling defect.
AD
Department of Medicine and Clinical Oncology Graduate School of Medicine Chiba University, Japan.
PMID
13
TI
Cholangioscopy and pancreatoscopy (with videos).
AU
Nguyen NQ, Binmoeller KF, Shah JN
SO
Gastrointest Endosc. 2009;70(6):1200.
 
AD
Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California 94115, USA.
PMID
14
TI
Is pancreatoscopy of any benefit in clarifying the diagnosis of pancreatic duct lesions?
AU
Jung M, Zipf A, Schoonbroodt D, Herrmann G, Caspary WF
SO
Endoscopy. 1998;30(3):273.
 
BACKGROUND AND STUDY AIMS: Modern fine-caliber endoscopes enable clinicians to directly visualize the pancreatic duct. They allow intraductal manipulation under optical control. We tried to evaluate the additional diagnostic potential of pancreatoscopy in assessing inconclusive intraductal pancreatic changes.
PATIENTS AND METHODS: We prospectively performed 20 pancreatoscopies in 18 patients with inconclusive ductal abnormalities that had been previously investigated by computed tomography (CT) scan, abdominal ultrasound and endoscopic retrograde cholangiopancreatography (ERCP). The CHF-BP 30 (Olympus Optical Co., Japan) endoscope with an outer diameter of 3.1 mm and an instrumentation channel of 1.2 mm was used. Biopsies, cytological brushing and fluid collection were carried out, and the site of ductal abnormality was visualized. Endoscopic sphincterotomy (EST) was carried out in every patient prior to insertion of the pancreatoscope.
RESULTS: Seven intraductal tumors were histologically confirmed, i.e. five intraductal papillary mucinous tumors and two adenocarcinomas. Benign appearance of the intraductal lesion plus negative histopathological examinations were confirmed by a follow-up of two years in eight patients. Five had chronic pancreatitis, and a further three had pancreatitis with strictures, blood clot obstruction, and idiopathic benign stricture, respectively. There were no complications with the exception of one bleeding episode after EST; no pancreatitis occurred.
CONCLUSIONS: Pancreatoscopy is of diagnostic value in addition to CT, transabdominal ultrasound and ERCP in the differential diagnosis of poorly defined pancreatic lesions, particularly when assessing alterations of the ductal caliber without parenchymatous lesions.
AD
Innere Abteilung, St. Hildegardis-Krankenhaus, Mainz, Germany.
PMID
15
TI
Cholangiopancreatoscopy for targeted biopsies of the bile and pancreatic ducts.
AU
Iqbal S, Stevens PD
SO
Gastrointest Endosc Clin N Am. 2009;19(4):567.
 
Establishing a tissue diagnosis in patients with suspected pancreaticobiliary malignancies remains challenging. Endoscopic retrograde cholangiopancreatography (ERCP)-based sampling methods have been reviewed in a previous issue of this journal but, unfortunately, the diagnostic yield continues to be inadequate in a significant minority of patients. The availability and image quality of cholangioscopy and pancreatoscopy have advanced in the last few years and our ability to make a diagnosis on imaging alone is improving. However, a definitive diagnosis requires tissue; cholangiopancreatoscopy allows targeted biopsies of the epithelium of the biliary and pancreatic ducts. This article reviews the evidence that cholangioscopy- and pancreatoscopy-guided biopsies improves diagnostic yield over ERCP-based tissue sampling techniques.
AD
Division of Digestive and Liver Diseases, Department of Medicine, Columbia University College of Physicians and Surgeons, P&S 10-508, 630 West 168th Street, NY 10032, USA.
PMID
16
TI
Peroral video cholangioscopy to evaluate indeterminate bile duct lesions and preoperative mucosal cancerous extension: a prospective multicenter study.
AU
Osanai M, Itoi T, Igarashi Y, Tanaka K, Kida M, Maguchi H, Yasuda K, Okano N, Imaizumi H, Itokawa F
SO
Endoscopy. 2013;45(8):635.
 
Background and study aims: Despite the development of peroral video cholangioscopy (PVCS), no prospective multicenter studies have been undertaken to investigate the diagnostic accuracy of PVCS in biliary tract diseases. Therefore, the aim of this study was to clarify the accuracy of PVCS in evaluating biliary tract lesions.Patients and methods: This study was a prospective multicenter study at five tertiary referral centers in Japan and included 87 eligible patients with biliary tract diseases who underwent PVCS. The study evaluated the ability of PVCS to diagnose indeterminate biliary tract diseases, detect mucosal cancerous extension preoperatively in extrahepatic bile duct cancers, and predict adverse events.Results: The use of PVCS appearance alone correctly distinguished benign from malignant indeterminate biliary lesions in 92.1 % of patients whereas biopsy alone was accurate in 85.7 %. In extrahepatic bile duct cancer, mucosal cancer extended histologically at least 20 mm in 34.7 % (17/49) of patients. The accuracy rate of PVCS to evaluate the presence or absence of mucosal cancerous extension by endoscopic retrograde cholangiography (ERC) alone, ERC with PVCS, and ERC with PVCS + biopsy were 73.5 %, 83.7 %, and 92.9 %, respectively. Adverse events were seen in 6.9 % of PVCS patients, but no serious complications were observed.Conclusion: PVCS enhanced the accurate diagnosis of biliary tract lesions by providing excellent resolution in combination with biopsy.
AD
Center for Gastroenterology Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan.
PMID
17
TI
Direct peroral cholangioscopy using an ultraslim upper endoscope for management of residual stones after mechanical lithotripsy for retained common bile duct stones.
AU
Lee YN, Moon JH, Choi HJ, Min SK, Kim HI, Lee TH, Cho YD, Park SH, Kim SJ
SO
Endoscopy. 2012 Sep;44(9):819-24. Epub 2012 Jul 12.
 
BACKGROUND AND STUDY AIMS: The incidence of residual stones after mechanical lithotripsy for retained common bile duct (CBD) stones is relatively high. Peroral cholangioscopy using a mother-baby system may be useful for confirming complete extraction of stones, but has several limitations regarding routine use. We evaluated the role of direct peroral cholangioscopy (DPOC) using an ultraslim upper endoscope for the evaluation and removal of residual CBD stones after mechanical lithotripsy.
PATIENTS AND METHODS: From August 2006 to November 2010, 48 patients who had undergone mechanical lithotripsy for retained CBD stones with no evidence of filling defects in balloon cholangiography were recruited. The bile duct was inspected by DPOC after balloon cholangiography. Detected residual CBD stones were directly retrieved with a basket or balloon catheter under DPOC. The incidence of residual stones detected by DPOC, and the success rate of residual stone retrieval under DPOC were investigated.
RESULTS: DPOC was successfully performed in 46 of the 48 patients (95.8%). Of these, 13 patients (28.3%) had residual CBD stones (mean number 1.4, range 1-3; mean diameter 4.5 mm, range 2.3-9.6). The residual stones were removed directly under DPOC in 11 of these patients (84.6%). There were no complications associated with DPOC or stone removal.
CONCLUSION: DPOC using an ultraslim upper endoscope is a useful endoscopic procedure for the evaluation and extraction of residual stones after mechanical lithotripsy for retained CBD stones.
AD
Digestive Disease Center, Department of Internal Medicine, Soon Chun Hyang University School of Medicine, Bucheon and Seoul, Korea.
PMID