PCS/PPS can be used to evaluate pancreatico-biliary lesions. AIM: To prospectively determine the clinical utility and diagnostic yield of PCS/PPS for evaluating lesions of the bile duct (BD) and pancreatic duct (PD). METHOD: 32 consecutive patients (59% men, mean age 59 yrs) underwent 35 ERCP and PCS/PPS with 2 systems: the mother-daughter system (MDS, Olympus M20 + CHF-B20, outer diam 4.5 mm, channel 1.7 mm) and the therapeutic duodenoscope (Olympus TJF-100) with a prototype scope (Olympus XCHF-B34Y, 3.4 mm outer diam, channel 1.2 mm). All pts had undiagnosed potentially malignant strictures and persistent filling defects of the BD (n=24) or PD (n=7) and/or multiple intrahepatic stones (n=3). 7 of 20 pts awaiting liver transplant had BD strictures and PSC. The endoscopist noted specific xray and endoscopic features and estimated the pre- and post-PCS/PPS probability of malignancy or stones. Cytologic, pathologic, and surgical results were correlated with patient follow-up. RESULTS: PCS and PPS successfully imaged the BD and PD in 96% and 71% of cases, respectively (p=0.11). 26% of lesions (16 strictures) were not traversible. Failure of PCS/PPS was associated with lack of previous endoscopic sphincterotomy or sphincter dilatation. The thinner XCHF-B34Y scope was more readily advanced into the BD or PD than the CHF-B20 of the MDS but biopsy acquisition was difficult with the former due to small channel caliber. 15/16 directed PCS/PPS biopsy attempts were successful (1-6 specimens) and only 2 biopsies had inadequate tissue. The mean maximum biopsy diameter was 1.5 mm. No specific ERCP (asymmetry, shelf, irregulariy, length, multiplicity) or endoscopic feature (asymmetry, mucosal discoloration, break, bleeding, friability, shelf-effect, firmness) was associated with presence of tumor. PCS led to a significant change in the estimated probability of tumor (p=.0001) but not residual stones (p=.71). The overall yield of PCS/PPS brushing/biopsy was 87% (Candida cholangitis=2, cholangioCA=3, benign tumor of BD/PD=3, inflammation=8, normal=1). PCS/PPS changed the diagnosis in 62%. PCS was more likely to lead to new/change in diagnosis (72%) than PPS (28%, p<.01). PCS and PPS change patient management in 47% of cases. CONCLUSIONS: PCS with targeted biopsy has a significant diagnostic yield which results in a significant change in diagnosis and management. The clinical utility of PPS is less than PCS.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging