Peroral cholangioscopy (PCS) and pancreatoscopy (PPS): Diagnostic yield, clinical impact, and technical considerations

Marcia Canto, M. V. Sivak, B. J. Pollack, A. Chak

Research output: Contribution to journalArticle

Abstract

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

Original languageEnglish (US)
JournalGastrointestinal Endoscopy
Volume45
Issue number4
StatePublished - 1997
Externally publishedYes

Fingerprint

Bile Ducts
Pancreatic Ducts
Biopsy
Pathologic Constriction
Endoscopic Retrograde Cholangiopancreatography
Neoplasms
Duodenoscopes
Endoscopic Sphincterotomy
Cholangitis
Nuclear Family
Candida
Dilatation
Mothers
X-Rays
Hemorrhage
Inflammation
Transplants
Liver

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Peroral cholangioscopy (PCS) and pancreatoscopy (PPS) : Diagnostic yield, clinical impact, and technical considerations. / Canto, Marcia; Sivak, M. V.; Pollack, B. J.; Chak, A.

In: Gastrointestinal Endoscopy, Vol. 45, No. 4, 1997.

Research output: Contribution to journalArticle

@article{aeb6215e128c4c85811bfd4da53e4d1e,
title = "Peroral cholangioscopy (PCS) and pancreatoscopy (PPS): Diagnostic yield, clinical impact, and technical considerations",
abstract = "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",
author = "Marcia Canto and Sivak, {M. V.} and Pollack, {B. J.} and A. Chak",
year = "1997",
language = "English (US)",
volume = "45",
journal = "Gastrointestinal Endoscopy",
issn = "0016-5107",
publisher = "Mosby Inc.",
number = "4",

}

TY - JOUR

T1 - Peroral cholangioscopy (PCS) and pancreatoscopy (PPS)

T2 - Diagnostic yield, clinical impact, and technical considerations

AU - Canto, Marcia

AU - Sivak, M. V.

AU - Pollack, B. J.

AU - Chak, A.

PY - 1997

Y1 - 1997

N2 - 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

AB - 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

UR - http://www.scopus.com/inward/record.url?scp=33748970307&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33748970307&partnerID=8YFLogxK

M3 - Article

AN - SCOPUS:33748970307

VL - 45

JO - Gastrointestinal Endoscopy

JF - Gastrointestinal Endoscopy

SN - 0016-5107

IS - 4

ER -