Digestive Endoscopy 2014; 27: 162–164
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Endoscopic transpapillary sampling methods for bile duct cancer: May intraductal aspiration improve diagnosis? We read with interest the article by Nishikawa et al.,1 recently published in the Journal, describing the factors affecting the accuracy of endoscopic transpapillary sampling methods for bile duct cancer. Authors reviewed the results from 101 consecutive patients with bile duct cancer. Accuracies of aspiration bile cytology were significantly higher for longer (≥15 mm) biliary cancerous lesions than for shorter lesions (30% vs 18%, respectively, P = 0.049). Accuracies of brushing cytology and fluoroscopic forceps biopsy were significantly higher for non-flat than for flat-type biliary cancerous lesions (brushing: 58% vs 38%, respectively, P = 0.032; forceps biopsy: 60% vs 33%, respectively, P = 0.043). In a previous study by our group, published in 2012,2 we evaluated intraductal aspiration (IDA) as a new sampling technique (brushing plus scraping and aspiration) in suspected malignant biliary strictures. To carry out IDA, we removed the brush from its catheter. The tip of the catheter was then scraped back and forth across the stricture at least 10 times. The catheter and a suction line were then connected to a specimen trap to obtain intraductal aspiration of fluids and samplings (Fig. 1). IDA showed a significantly higher sensitivity than brushing (89% vs 37%; P < 0.001) with a superior cellular adequacy (92.8% vs 35.7%; P < 0.001), appearing safe, simple, rapid, and applicable during routine diagnostic ERCP, with no additional costs. In conclusion, while not calling into question the validity of Dr Nishikawa’s findings, a randomized, controlled trial comparing IDA with other sampling methods might provide further interesting results and investigate whether IDA could improve ERCP-based diagnostic accuracy especially in the case of ‘difficult to sample’ lesions such as short or flat-type biliary cancer.
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Figure 1 Standard brushing catheter (a) before and (b) after removing the brush. (c) Intraductal aspiration catheter and suction line connected to a specimen trap.
Authors declare no conflict of interests for this article. Gabriele Curcio, Dario Ligresti and Mario Traina Endoscopy Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
doi: 10.1111/den.12393
REFERENCES 1 Nishikawa T, Tsuyuguchi T, Sakai Y et al. Factors affecting the accuracy of endoscopic transpapillary sampling methods for bile duct cancer. Dig. Endosc. 2014; 26: 276–81. 2 Curcio G, Traina M, Mocciaro F et al. Intraductal aspiration: A promising new tissue-sampling technique for the diagnosis of suspected malignant biliary strictures. Gastrointest. Endosc. 2012; 75: 798–804.
Endoscopic ultrasound-guided celiac ganglion radiofrequency ablation for pain control in pancreatic carcinoma A 57-year-old man was diagnosed with pancreatic cancer with liver metastasis by computed tomography (CT) (Fig. 1a). Endoscopic ultrasound-guided fine-needle aspiration (EUSFNA) revealed a pathology diagnosis of pancreatic cancer (Fig. 1b). The patient had undergone EUS-guided radiofrequency ablation (RFA) 2 months prior to presentation (Fig. 2a). However, the patient had a visual analog scale (VAS) score of 8 and received 40 mg oral opioid analgesics every 2 h. For pain control, EUS-guided celiac ganglion RFA was carried out. First, an EUS-guided puncture of the celiac ganglion was done using a 19-gauge EUS needle. Second, a RF probe, EMcision Company, Montreal, Canada, was advanced into the needle to the center of the celiac ganglion, then the needle was withdrawn to the border in order to disengage contact with the active part of the probe. With the application of RFA, the center of the celiac ganglion gradually became hyperechoic (Fig. 2b–d; Video 1). Ablation parameters were set as follows: fixed RF power (heating) was 10 W for 120 s and 15 W for 120 s. Three days after the procedure, the patient’s VAS score decreased to 2, thereby eliminating the need for opioid anal-
Figure 1 (a) Contrast computed tomography showing the pancreatic tail mass. (b) Endoscopic ultrasound-guided fine-needle aspiration slide showing the malignancy.
© 2014 The Authors Digestive Endoscopy © 2014 Japan Gastroenterological Endoscopy Society
Copyright of Digestive Endoscopy is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
163
Endoscopic transpapillary sampling methods for bile duct cancer: May intraductal aspiration improve diagnosis? We read with interest the article by Nishikawa et al.,1 recently published in the Journal, describing the factors affecting the accuracy of endoscopic transpapillary sampling methods for bile duct cancer. Authors reviewed the results from 101 consecutive patients with bile duct cancer. Accuracies of aspiration bile cytology were significantly higher for longer (≥15 mm) biliary cancerous lesions than for shorter lesions (30% vs 18%, respectively, P = 0.049). Accuracies of brushing cytology and fluoroscopic forceps biopsy were significantly higher for non-flat than for flat-type biliary cancerous lesions (brushing: 58% vs 38%, respectively, P = 0.032; forceps biopsy: 60% vs 33%, respectively, P = 0.043). In a previous study by our group, published in 2012,2 we evaluated intraductal aspiration (IDA) as a new sampling technique (brushing plus scraping and aspiration) in suspected malignant biliary strictures. To carry out IDA, we removed the brush from its catheter. The tip of the catheter was then scraped back and forth across the stricture at least 10 times. The catheter and a suction line were then connected to a specimen trap to obtain intraductal aspiration of fluids and samplings (Fig. 1). IDA showed a significantly higher sensitivity than brushing (89% vs 37%; P < 0.001) with a superior cellular adequacy (92.8% vs 35.7%; P < 0.001), appearing safe, simple, rapid, and applicable during routine diagnostic ERCP, with no additional costs. In conclusion, while not calling into question the validity of Dr Nishikawa’s findings, a randomized, controlled trial comparing IDA with other sampling methods might provide further interesting results and investigate whether IDA could improve ERCP-based diagnostic accuracy especially in the case of ‘difficult to sample’ lesions such as short or flat-type biliary cancer.
bs_bs_banner
Figure 1 Standard brushing catheter (a) before and (b) after removing the brush. (c) Intraductal aspiration catheter and suction line connected to a specimen trap.
Authors declare no conflict of interests for this article. Gabriele Curcio, Dario Ligresti and Mario Traina Endoscopy Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
doi: 10.1111/den.12393
REFERENCES 1 Nishikawa T, Tsuyuguchi T, Sakai Y et al. Factors affecting the accuracy of endoscopic transpapillary sampling methods for bile duct cancer. Dig. Endosc. 2014; 26: 276–81. 2 Curcio G, Traina M, Mocciaro F et al. Intraductal aspiration: A promising new tissue-sampling technique for the diagnosis of suspected malignant biliary strictures. Gastrointest. Endosc. 2012; 75: 798–804.
Endoscopic ultrasound-guided celiac ganglion radiofrequency ablation for pain control in pancreatic carcinoma A 57-year-old man was diagnosed with pancreatic cancer with liver metastasis by computed tomography (CT) (Fig. 1a). Endoscopic ultrasound-guided fine-needle aspiration (EUSFNA) revealed a pathology diagnosis of pancreatic cancer (Fig. 1b). The patient had undergone EUS-guided radiofrequency ablation (RFA) 2 months prior to presentation (Fig. 2a). However, the patient had a visual analog scale (VAS) score of 8 and received 40 mg oral opioid analgesics every 2 h. For pain control, EUS-guided celiac ganglion RFA was carried out. First, an EUS-guided puncture of the celiac ganglion was done using a 19-gauge EUS needle. Second, a RF probe, EMcision Company, Montreal, Canada, was advanced into the needle to the center of the celiac ganglion, then the needle was withdrawn to the border in order to disengage contact with the active part of the probe. With the application of RFA, the center of the celiac ganglion gradually became hyperechoic (Fig. 2b–d; Video 1). Ablation parameters were set as follows: fixed RF power (heating) was 10 W for 120 s and 15 W for 120 s. Three days after the procedure, the patient’s VAS score decreased to 2, thereby eliminating the need for opioid anal-
Figure 1 (a) Contrast computed tomography showing the pancreatic tail mass. (b) Endoscopic ultrasound-guided fine-needle aspiration slide showing the malignancy.
© 2014 The Authors Digestive Endoscopy © 2014 Japan Gastroenterological Endoscopy Society
Copyright of Digestive Endoscopy is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
