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Endoscopic retrograde cholangiography versus peroral cholangioscopy to evaluate intraepithelial tumor spread in biliary cancer

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Title: Endoscopic retrograde cholangiography versus peroral cholangioscopy to evaluate intraepithelial tumor spread in biliary cancer
Authors: Kawakami, Hiroshi Browse this author
Kuwatani, Masaki Browse this author
Etoh, Kazunori Browse this author
Haba, Shin Browse this author
Yamato, Hiroaki Browse this author
Shinada, Keisuke Browse this author
Nakanishi, Yoshitsugu Browse this author
Tanaka, Eiichi Browse this author
Hirano, Satoshi Browse this author
Kondo, Satoshi Browse this author
Kubota, Kanako Browse this author
Asaka, Masahiro Browse this author
Issue Date: Nov-2009
Publisher: Georg Thieme Verlag
Journal Title: Endoscopy
Volume: 41
Issue: 11
Start Page: 959
End Page: 964
Publisher DOI: 10.1055/s-0029-1215178
PMID: 19802775
Abstract: Background and study aims: Localized-type bile duct carcinoma (LBDC) is often accompanied by extensive intraepithelial tumor spread (ITS) ≥2 cm which makes radical resection more difficult. This retrospective case review compared the diagnostic accuracy of endoscopic retrograde cholangiography (ERC) and peroral cholangioscopy (POCS) to detect ITS beyond the visible LBDCs. Patients and methods: Forty-four consecutive LBDC patients diagnosed between April 2004 to October 2008 who underwent radical resection with histopathological analysis were included in this study. Extensive ITS was found histopathologically in one-third of the cases (32%). The outcome parameters were the presence or absence of extensive ITS and the extent of extensive ITS proximal and distal to the main tumor. Results: It was not possible to pass the cholangioscopic through the tumor sites in 6 cases. ERC correctly identified the presence of extensive ITS in 11/14 cases and did not yield any false-positive results. The three ERC-negative cases were all correctly identified by POCS plus biopsy since the cholangioscope could be passed in all three cases. The extent of extensive ITS was correctly diagnosed by ERC alone, ERC with POCS, and ERC with POCS plus mapping biopsy in 22%, 77%, and 100% of cases, respectively. Conclusions: The presence of extensive ITS could be correctly detected in 80% of cases by ERC alone. POCS with mapping biopsy provided perfect diagnostic accuracy of not only the presence/absence but also the extent of extensive ITS. However, POCS has the limitation that the cholangioscope cannot be passed through the tumor sites in approximately 15% of cases.
Rights: © 2009 Georg Thieme Verlag
Type: article (author version)
URI: http://hdl.handle.net/2115/44111
Appears in Collections:北海道大学病院 (Hokkaido University Hospital) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

Submitter: 河上 洋

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