Cholangioscopy- versus fluoroscopy-guided transpapillary mapping biopsy for preoperative evaluation of extrahepatic cholangiocarcinoma: a prospective randomized crossover study

Abstract Background and study aims Evaluation of longitudinal tumor extent is indispensable for curative surgical treatment of extrahepatic cholangiocarcinoma. The aim of this study was to evaluate the usefulness and feasibility of cholangioscopic-guided mapping biopsy using a newly developed peroral digital cholangioscope, SpyGlass DS (SpyDS), for preoperative evaluation of extrahepatic cholangiocarcinoma. Patients and methods Thirteen patients (mean age, 75 years; male 10, female 3) with extrahepatic cholangiocarcinoma who underwent cholangioscopic-guided mapping biopsy using SpyDS for preoperative evaluation were included in this study. Successful cholangioscopic-guided mapping biopsy was defined as the acquisition of specimens sufficient for histopathological diagnosis. Results The mean number of biopsies was 5 per patient. The overall success rate for cholangioscopic-guided mapping biopsy was 88 % (59/67). The success rate for cholangioscopic-guided mapping biopsy from the confluence of the right and left hepatic ducts was 89 %, that from the B4 confluence was 93 %, that from the confluence of the right anterior and right posterior segmental ducts was 86 %, that from the intrapancreatic common bile duct was 67 %, and that from the main lesion was 100 %. The overall diagnostic accuracy of longitudinal tumor extent at the hepatic side, the duodenal side and overall by cholangioscopic findings and mapping biopsy, was 88 % (7/8), 88 % (7/8) and 88 % (7/8), respectively. Assessment according to location of the main lesion revealed that diagnostic accuracy in the patients with distal bile duct carcinoma was 100 % (5/5) and that in patients with perihilar bile duct carcinoma was 66 % (2/3). Complications after the procedure did not occur in any patients. Conclusions Cholangioscopic-guided mapping biopsy using SpyDS is thought to be feasible for preoperative evaluation of extrahepatic cholangiocarcinoma.

Download Full-text

The Effect of Two Isocaloric and Energy-Matched Plant-Based and Processed-Meat Meals on Glucose Metabolism, Gastrointestinal Hormones, and Satiety in Subjects with T2D, Obese Subjects, and Healthy Controls—A Randomized Crossover Study

Diabetes ◽

10.2337/db18-784-p ◽

2018 ◽

Vol 67 (Supplement 1) ◽

pp. 784-P ◽

Cited By ~ 1

Author(s):

MARTA KLEMENTOVA ◽

LENKA BELINOVA ◽

MARTIN HALUZIK ◽

RENATA PAVLOVICOVA ◽

MARTIN HILL ◽

...

Keyword(s):

Glucose Metabolism ◽

Crossover Study ◽

Gastrointestinal Hormones ◽

Processed Meat ◽

Healthy Controls ◽

Obese Subjects ◽

Randomized Crossover Study

Download Full-text

755-P: A Plant-Based Meal Stimulates Incretin and Insulin Secretion More than an Energy- and Macronutrient-Matched Standard Meal in Type 2 Diabetes: A Randomized Crossover Study

Diabetes ◽

10.2337/db19-755-p ◽

2019 ◽

Vol 68 (Supplement 1) ◽

pp. 755-P

Author(s):

HANA KAHLEOVA ◽

ANDREA TURA ◽

MARTA KLEMENTOVA ◽

LENKA BELINOVA ◽

MARTIN HALUZIK ◽

...

Keyword(s):

Type 2 Diabetes ◽

Insulin Secretion ◽

Crossover Study ◽

Standard Meal ◽

Randomized Crossover Study

Download Full-text

Faculty Opinions recommendation of Sacral neuromodulation in children with urinary and fecal incontinence: a multicenter, open label, randomized, crossover study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.3749956.4297082 ◽

2010 ◽

Author(s):

Carlo Di Lorenzo

Keyword(s):

Fecal Incontinence ◽

Crossover Study ◽

Sacral Neuromodulation ◽

Open Label ◽

Randomized Crossover Study

Download Full-text

Faculty Opinions recommendation of Ecological momentary assessment for chronic pain in fibromyalgia using a smartphone: a randomized crossover study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718473110.793530446 ◽

2017 ◽

Author(s):

Christopher Eccleston

Keyword(s):

Chronic Pain ◽

Crossover Study ◽

Ecological Momentary Assessment ◽

Ecological Momentary ◽

Momentary Assessment ◽

Randomized Crossover Study

Download Full-text

Faculty Opinions recommendation of Emergency Cricothyrotomy Performed by Surgical Airway-naive Medical Personnel: A Randomized Crossover Study in Cadavers Comparing Three Commonly Used Techniques.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726406126.793528520 ◽

2017 ◽

Author(s):

Michael Aziz

Keyword(s):

Crossover Study ◽

Medical Personnel ◽

Surgical Airway ◽

Randomized Crossover Study

Download Full-text

Faculty Opinions recommendation of Canagliflozin triggers the FGF23/1,25-dihydroxyvitamin D/PTH axis in healthy volunteers in a randomized crossover study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.733184143.793551048 ◽

2018 ◽

Author(s):

Coen Stehouwer ◽

Martijn Brouwers

Keyword(s):

Crossover Study ◽

Healthy Volunteers ◽

Dihydroxyvitamin D ◽

1,25 Dihydroxyvitamin D ◽

Randomized Crossover Study

Download Full-text

Robotic-assisted cholecystectomy is superior to laparoscopic cholecystectomy in the initial training for surgical novices in an ex vivo porcine model: a randomized crossover study

Surgical Endoscopy ◽

10.1007/s00464-021-08373-6 ◽

2021 ◽

Author(s):

E. Willuth ◽

S. F. Hardon ◽

F. Lang ◽

C. M. Haney ◽

E. A. Felinska ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Crossover Study ◽

Porcine Model ◽

Haptic Feedback ◽

Ex Vivo ◽

Operating Time ◽

Surgical Performance ◽

Robotic Assisted ◽

Subjective Workload ◽

Randomized Crossover Study

Abstract Background Robotic-assisted surgery (RAS) potentially reduces workload and shortens the surgical learning curve compared to conventional laparoscopy (CL). The present study aimed to compare robotic-assisted cholecystectomy (RAC) to laparoscopic cholecystectomy (LC) in the initial learning phase for novices. Methods In a randomized crossover study, medical students (n = 40) in their clinical years performed both LC and RAC on a cadaveric porcine model. After standardized instructions and basic skill training, group 1 started with RAC and then performed LC, while group 2 started with LC and then performed RAC. The primary endpoint was surgical performance measured with Objective Structured Assessment of Technical Skills (OSATS) score, secondary endpoints included operating time, complications (liver damage, gallbladder perforations, vessel damage), force applied to tissue, and subjective workload assessment. Results Surgical performance was better for RAC than for LC for total OSATS (RAC = 77.4 ± 7.9 vs. LC = 73.8 ± 9.4; p = 0.025, global OSATS (RAC = 27.2 ± 1.0 vs. LC = 26.5 ± 1.6; p = 0.012, and task specific OSATS score (RAC = 50.5 ± 7.5 vs. LC = 47.1 ± 8.5; p = 0.037). There were less complications with RAC than with LC (10 (25.6%) vs. 26 (65.0%), p = 0.006) but no difference in operating times (RAC = 77.0 ± 15.3 vs. LC = 75.5 ± 15.3 min; p = 0.517). Force applied to tissue was similar. Students found RAC less physical demanding and less frustrating than LC. Conclusions Novices performed their first cholecystectomies with better performance and less complications with RAS than with CL, while operating time showed no differences. Students perceived less subjective workload for RAS than for CL. Unlike our expectations, the lack of haptic feedback on the robotic system did not lead to higher force application during RAC than LC and did not increase tissue damage. These results show potential advantages for RAS over CL for surgical novices while performing their first RAC and LC using an ex vivo cadaveric porcine model. Registration number researchregistry6029 Graphic abstract

Download Full-text