scholarly journals Sufficient Tissue Acquisition Rate of Peroral Cholangioscopy-guided Forceps Biopsy

2019 ◽  
Author(s):  
Takumi Onoyama ◽  
Yohei Takeda ◽  
Soichiro Kawata ◽  
Hiroki Kurumi ◽  
Hiroki Koda ◽  
...  
Keyword(s):  
Bile Duct ◽  
Biliary Tract ◽  
Biliary Disease ◽  
Acquisition Rate ◽  
Factors Affecting ◽  
Forceps Biopsy ◽  
Tract Cancer ◽  
Peroral Cholangioscopy ◽  
Tissue Acquisition ◽  
Mapping Biopsy

Abstract Background: Peroral cholangioscopy (POCS)-guided forceps biopsy is a method for diagnosing indeterminate biliary strictures and for the preoperative identification of the exact perihilar and distal margins of biliary tract cancer (BTC). However, POCS-guided forceps biopsy may result in an insufficient amount of specimen at times. Aims: We evaluated the sufficient tissue acquisition rate and the factors affecting the sufficient tissue acquisition of POCS-guided forceps biopsy for the biliary tract. Methods: Patients who underwent POCS-guided forceps biopsy for biliary disease between September 2016 and October 2018 at our hospital were enrolled retrospectively. We evaluated the sufficient tissue acquisition rate of POCS-guided forceps biopsy for the biliary lesion and that for non-stenotic bile duct. In addition, the factors affecting the sufficient tissue acquisition rate of POCS-guided forceps biopsy were evaluated. Results and Conclusions : We enrolled 47 patients with the biliary disease and performed POCS-guided forceps biopsy for biliary lesion and POCS-guided forceps mapping biopsy for non-stenotic bile duct in 40 and 36 patients, respectively. The sufficient tissue acquisition rates of POCS-guided forceps biopsy for biliary lesions and that for non-stenotic bile duct were 86.4%, and 68.9%, respectively. In the multivariate logistic regression analyses, age and previous biliary stenting before POCS were factors affecting the sufficient tissue acquisition rate of POCS-guided forceps biopsy for the biliary lesion. For non-stenotic bile duct, the location of the biliary lesion, endoscopic sphincterotomy, and procedure time of POCS were factors affecting the sufficient tissue acquisition rate of POCS-guided forceps mapping biopsy.

scholarly journals Peroral Cholangioscopy-Guided Forceps Mapping Biopsy for Evaluation of the Lateral Extension of Biliary Tract Cancer

2021 ◽  
Vol 10 (4) ◽  
pp. 597
Author(s):  
Takumi Onoyama ◽  
Wataru Hamamoto ◽  
Yuri Sakamoto ◽  
Shiho Kawahara ◽  
Taro Yamashita ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Biliary Tract ◽  
Biliary Tract Cancer ◽  
Diagnostic Value ◽  
Lateral Extension ◽  
Factors Affecting ◽  
Tract Cancer ◽  
Peroral Cholangioscopy ◽  
Biliary Tracts ◽  
Mapping Biopsy

Background: Peroral cholangioscopy (POCS)-guided forceps mapping biopsy (FMB) is a method for the accurate preoperative identification of the extent of the disease of biliary tract cancer (BTC). However, the diagnostic value of POCS-FMB is still uncertain. Objectives: We evaluated the diagnostic utility of POCS-FMB for the identification of lateral extension—superficial intraductal spread longitudinally and continuously from the main lesion—of BTC. Methods: In the retrospective study, patients who received POCS-FMB and surgery for curative resection of BTC between September 2016 and August 2019 at our medical institution were enrolled. The diagnostic accuracy of POCS-FMB for the identification of lateral extension of BTC was evaluated. Furthermore, we also evaluated the factors affecting the diagnostic accuracy of POCS-FMB. Results: A total of 23 patients with BTC were enrolled, and 24 procedures of POCS-FMB from 96 sites of biliary tracts were performed. The sensitivity, specificity, and accuracy of POCS-FMB were 53.8%, 63.9%, and 63.1%, respectively. In the multivariate logistic regression analyses, the biopsy from the bifurcation of biliary tracts was a significant factor affecting the diagnostic accuracy of POCS-FMB (odds ratio 3.538, 95%; confidence interval 1.151–10.875, p = 0.027). Conclusions: The diagnostic accuracy of POCS-FMB for the identification of lateral extension of BTC was insufficient. The biopsy from the bifurcation of biliary tracts was a positive factor affecting the diagnostic accuracy of POCS-FMB.

scholarly journals Dysbiosis of the faecal and biliary microbiotas in biliary tract cancer

2021 ◽  
Author(s):  
Zensho Ito ◽  
Shigeo Koido ◽  
Kumiko Kato ◽  
Toshitaka Odamaki ◽  
Sankichi Horiuchi ◽  
...  
Keyword(s):  
Bile Duct ◽  
Biliary Tract ◽  
Biliary Tract Cancer ◽  
Biliary Tract Disease ◽  
Rrna Gene ◽  
Biliary Disease ◽  
Faecal Microbiota ◽  
Linear Discriminant ◽  
Tract Cancer ◽  
Bacteria In The Bile

Abstract Background Characteristic bile duct and colonic microbiotas have been identified in patients with chronic biliary tract disease. Therefore, a characteristic microbiota is likely also formed in cholangio- and gallbladder carcinoma patients. This study aimed to characterize the faecal and bile microbiotas in biliary tract cancer (BTC) patients and their relationship to each other. Methods Patients with BTC (n = 30) and benign biliary disease (BBD) without cholangitis (n = 11) were prospectively included. Ten healthy, age-matched subjects were also recruited for faecal microbiota comparison. The colon and bile duct microbiotas were analysed by sequencing the 16S rRNA gene V3-V4 region. We also obtained live bacteria in the bile collected from three BTC patients by culture and performed metagenomics-based identification. Results The faecal microbiota composition differed in the BTC patients. Linear discriminant analysis (LDA) effect size (LEfSe) showed a higher Enterobacteriaceae abundance and a lower Clostridia abundance, including that of butyrate-producing bacteria including Faecalibacterium and Coprococcus, in the BTC patients than in the other subjects. Notably, 10 of 17 operational taxonomic units (OTUs) assigned to Enterobacteriaceae in the bile samples were matched with the OTUs found in the BTC subject faecal samples. Further metagenomic approaches revealed a bile-isolated strain that possessed the carcinogenic bacterial colipolyketide synthase (PKS)-encoding gene. Conclusions Enterobacteriaceae was enriched in the BTC faeces. Taken together with the finding that more than half of Enterobacteriaceae in the bile matched that in the faeces at the OTU level, our data suggest that faecal microbiota dysbiosis possibly contributes to BTC onset.

scholarly journals Peroral Cholangioscopy-Guided Forceps Biopsy and Endoscopic Scraper for the Diagnosis of Indeterminate Extrahepatic Biliary Stricture

2019 ◽  
Vol 8 (6) ◽  
pp. 873 ◽  
Author(s):  
Masayuki Kato ◽  
Takumi Onoyama ◽  
Yohei Takeda ◽  
Soichiro Kawata ◽  
Hiroki Kurumi ◽  
...  
Keyword(s):  
Adverse Events ◽  
Sphincter Of Oddi ◽  
Diagnostic Utility ◽  
Biliary Disease ◽  
Extrahepatic Cholangiocarcinoma ◽  
Forceps Biopsy ◽  
Peroral Cholangioscopy ◽  
Pathological Evaluation ◽  
Tissue Acquisition ◽  
Sensitivity Specificity

Background: Peroral cholangioscopy (POCS) has become a widely-used technique in diagnosing indeterminate biliary strictures, enabling optical viewing of the biliary system and targeted biopsies under direct vision. The diagnostic utility of the new endoscopic scraper, Trefle®, for extrahepatic cholangiocarcinoma (ECC) has also been reported. However, the diagnostic utility of POCS-guided and Trefle®-assisted tissue acquisition for ECC has never been compared empirically. We evaluated the efficacy and safety of Trefle®-assisted tissue acquisition for diagnosing ECC compared with POCS-guided tissue sampling. Methods: Patients who underwent Trefle®-assisted tissue acquisition or POCS-guided forceps biopsy to differentiate ECC from benign biliary disease between April 2014 and March 2018 were enrolled retrospectively. We evaluated the diagnostic performance of Trefle®-assisted tissue acquisition and POCS-guided forceps biopsy based on pathological evaluation. We also compared adverse events associated with Trefle®-assisted tissue acquisition with those of POCS-guided forceps biopsy. Results: We enrolled 34 patients with biliary disease and performed Trefle®-assisted tissue acquisition and POCS-guided forceps biopsy in 14 and 20 patients, respectively. Sensitivity, specificity, and accuracy of Trefle®-assisted tissue acquisition were 87.5%, 83.3%, and 85.7%, respectively, and for POCS-guided forceps biopsy, these were 90.0% each. Statistical values of Trefle®-assisted tissue acquisition and POCS-guided tissue acquisition were not significantly different. There were no significant differences in the occurrence of adverse events between the Trefle®-assisted tissue acquisition and the POCS-guided forceps biopsy (35.7% vs. 25.0%, p = 0.770). Compared with patients who underwent POCS procedure, endoscopic sphincterotomy was performed for fewer patients who underwent Trefle®-assisted tissue acquisition (p < 0.001). Conclusions: The diagnostic ability of Trefle®-assisted tissue acquisition for ECC is similar to that of POCS-guided tissue acquisition. Trefle®-assisted tissue acquisition might also help to preserve the sphincter of Oddi and its digestive function.

scholarly journals Adequate tissue acquisition rate of peroral cholangioscopy-guided forceps biopsy

2020 ◽  
Vol 8 (17) ◽  
pp. 1073-1073
Author(s):  
Takumi Onoyama ◽  
Yohei Takeda ◽  
Soichiro Kawata ◽  
Hiroki Kurumi ◽  
Hiroki Koda ◽  
...  
Keyword(s):  
Acquisition Rate ◽  
Forceps Biopsy ◽  
Peroral Cholangioscopy ◽  
Tissue Acquisition ◽  
Adequate Tissue

scholarly journals Adjuvant and neoadjuvant therapy for biliary tract cancer: a review of clinical trials

2020 ◽  
Vol 50 (12) ◽  
pp. 1353-1363 ◽  
Author(s):  
Satoshi Nara ◽  
Minoru Esaki ◽  
Daisuke Ban ◽  
Takeshi Takamoto ◽  
Kazuaki Shimada ◽  
...  
Keyword(s):  
Overall Survival ◽  
Clinical Trials ◽  
Bile Duct ◽  
Adjuvant Therapy ◽  
Neoadjuvant Therapy ◽  
Biliary Tract ◽  
Biliary Tract Cancer ◽  
Tract Cancer ◽  
Adjuvant And Neoadjuvant Therapy ◽  
Duct Cancer

Abstract Cancer originating in the biliary tract can be classified as bile duct cancer (cholangiocarcinoma), gallbladder cancer, or ampullary cancer. Bile duct cancer is further divided to intrahepatic, perihilar and distal bile duct subtypes according to the anatomical location of the tumor. The biological characteristics of each tumor are heterogeneous. However, because of the rarity of each disease, the efficacy of new drugs has been tested in groups of patients with different biliary tract cancers. In patients with metastatic or recurrent biliary tract cancer, recent randomized clinical trials revealed the non-inferiority of gemcitabine + S-1 and the superiority of gemcitabine + cisplatin + S-1 compared with gemcitabine + cisplatin in terms of overall survival, thereby establishing a new standard treatment. In the field of adjuvant therapy for biliary tract cancer, the British BILCAP (capecitabine compared with observation in resected biliary tract cancer) study revealed longer median overall survival in the capecitabine group than in the observation group in the per-protocol analysis (but not in the intention-to-treat analysis), bringing a shift toward postoperative management. Several other studies of adjuvant therapy are ongoing, and they may lead to reforms in treatment strategy for resectable biliary tract cancer in the future. The use of neoadjuvant therapy for biliary tract cancer is in its infancy, but it is expected to overcome the limitations of adjuvant therapy for this malignancy. In this review, we summarized the evidence available from clinical trials of adjuvant and neoadjuvant therapy for biliary tract cancer and described ongoing clinical trials.

Analysis of 94 patients with advanced biliary tract cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 15172-15172
Author(s):  
B. Andritzky ◽  
S. Adler ◽  
I. Burkholder ◽  
I. Thöm ◽  
G. Schuch ◽  
...  
Keyword(s):  
Overall Survival ◽  
Bile Duct ◽  
Biliary Tract ◽  
Biliary Tract Cancer ◽  
Primary Tumor ◽  
Median Overall Survival ◽  
Response Rate ◽  
Cytotoxic Agents ◽  
Tract Cancer ◽  
Line Chemotherapy

15172 Background: Cholangiocarcinoma or gallbladder cancer are often diagnosed at an advanced stage with limited treatment options. Methods: Between 1994 and 2004, 94 patients (pts) (47 male, 47 female) with advanced biliary tract cancer were treated at the Department of Oncology and Hematology, University Hospital Hamburg-Eppendorf. Clinical and histopathological characteristics, response to chemotherapy, and survival were investigated in a retrospective analysis. Median age was 59 years (range 30–80) and median Karnofsky performance status was 90%. Predominant histologic type was adenocarcinoma (94.7%). Primary tumor sites were extrahepatic bile duct (29.9%), gallbladder (28.7%), intrahepatic bile duct (10.6%), ampulla of Vater (2.1%), not specified (28.7%). Predominant localizations of metastases were liver (73 pts (77.7%)), lymph nodes (49 pts (52.1%)) and the peritoneum (14 pts (14.9%)). 33 pts (35.1%) underwent surgery of the primary tumor at time of diagnosis. Results: 72 of 94 pts (76.6%) received a first-line chemotherapy, all together 10 different chemotherapy regimens were used. The median number of cycles was 2.5 (range 1 - 12). A single agent chemotherapy with gemcitabine was the most often adminstered regimen (23 pts (31.9%)), followed by carboplatin and etoposide plus whole body hyperthermia (12 pts (16.7%)) and 5- fluorouracil and folic acid (10 pts (13.9%)). The overall response rate was 8.3% (95% CI 3.1 - 17.3) (34.7% SD, 47.2% PD, 9.7% not evaluable). Second-line chemotherapy was given in 27 patients, which induced no tumor response, but a stable disease rate of 22.2%. Median time to follow- up was 44.8 months. Survival was calculated for all 94 pts since time of diagnosis. Median overall survival was 12.2 months and median progression-free survival 9.2 months. The median overall survival time for the 72 pts who were treated with chemotherapy was 14.0 months, and for the 22 pts who did not receive chemotherapy 10.7 months (p=0.2). Conclusions: Our analysis showed a poor prognosis for patients with advanced biliary tract cancer. Response rate to chemotherapy was low. Therefore, well tolerated cytotoxic agents should be used and new treatment strategies (including molecular targeted therapy) should be further investigated. No significant financial relationships to disclose.

scholarly journals Smoking, Alcohol Consumption, and Risks for Biliary Tract Cancer and Intrahepatic Bile Duct Cancer

2019 ◽  
Vol 29 (5) ◽  
pp. 180-186 ◽  
Author(s):  
Takeshi Makiuchi ◽  
Tomotaka Sobue ◽  
Tetsuhisa Kitamura ◽  
Norie Sawada ◽  
Motoki Iwasaki ◽  
...  
Keyword(s):  
Bile Duct ◽  
Alcohol Consumption ◽  
Biliary Tract ◽  
Biliary Tract Cancer ◽  
Bile Duct Cancer ◽  
Intrahepatic Bile Duct ◽  
Tract Cancer ◽  
Duct Cancer

Prognostic factor analysis of second-line chemotherapy in advanced biliary tract cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14688-e14688 ◽  
Author(s):  
Sang-Cheol Lee ◽  
Kyoungha Kim ◽  
Hanjo Kim ◽  
Hyun Jung Kim ◽  
Se Hyung Kim ◽  
...  
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
Biliary Tract ◽  
Biliary Tract Cancer ◽  
Salvage Chemotherapy ◽  
Second Line ◽  
First Line ◽  
Factors Affecting ◽  
Tract Cancer ◽  
Line Chemotherapy

e14688 Background: There is no evidence that second-line chemotherapy in advanced biliary tract cancer (BTC) will result in substantial prolongation of survival. The purpose of this study was to evaluate prognostic factors for the survival of patients with advanced biliary tract cancer who was refractory BTC for first-line chemotherapy. Methods: We reviewed 89 patients retrospecitively with advanced biliary tract cancer who had enrolled in two clinical trials at three branches of Soonchunhyang university hospital. They received palliative chemotherapy with 2 regimens (biweekly GEMOX and modified FOLFOX-6). GEMOX is consist of gemcitabine 1,000 mg/m2 intravenously on day 1 and oxaliplatin 85 mg/m2 intravenously on day 2 every 2 weeks and mFOLFOX-6 is that oxaliplatin 85mg/m2 and folinic acid 400 mg/m2 on day 1 follwed by a 5-FU bolus 400 mg/m2 and 46-h infusion 2400 mg/m2 every 2 weeks. To evaluate the clinicopathologic factors that affected overall survival, univariate and multivariate analyses were performed on the baseline factors. Results: 89 patients were enrolled from Sep 2006 to Aug 2010. Medain age was 62.14 years (range 35-81). Univariate analysis revealed 4 prognostic factors affecting overall survival after first-line chemotherapy. Performance status of 0-1 vs >2 (p=0.014), salvage chemotherapy (p=0.021), locoregional disease vs disseminated disease (p=0.046) and responder of first-line chemotherapy (p=0.025) was revealed. Multivariate analysis found 2 prognostic factors affecting overall survival. They were salvage chemotherapy and initial responder. Conclusions: This results suggest that 2nd-line chemotherapy is needed for patients with good performance and responder of initial chemotherapy.

Frequency of severe neutropenia occurring as an adverse events of gemcitabine plus cisplatin chemotherapy in patients with recurrent biliary tract cancer compared to those with unresectable biliary tract cancer.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 488-488
Author(s):  
Noriko Fujishiro ◽  
Shuichi Mitsunaga ◽  
Akira Shinohara ◽  
Misaki K Takeno ◽  
Hideki Funazaki ◽  
...  
Keyword(s):  
Bile Duct ◽  
Adverse Events ◽  
Biliary Tract ◽  
Biliary Tract Cancer ◽  
Intrahepatic Bile Duct ◽  
Severe Neutropenia ◽  
Primary Tumor Site ◽  
Tract Cancer ◽  
Significant Difference ◽  
Grade 3

488 Background: In patients (pts) with biliary tract cancer (BTC), relapse occurs at a high frequency even after curative resection. It remains unclear whether in pts with postoperative recurrence receiving chemotherapy, the surgery exerts any influence on the risk of development of toxicities. The aim of this study was to compare the outcomes and incidences of adverse events between recurrent BTC (rBTC) pts and unresectable BTC (uBTC) pts receiving gemcitabine plus cisplatin chemotherapy (GC). Methods: Data of pts with rBTC or uBTC receiving GC as the first-line chemotherapy were analyzed. The GC regimen consisted of gemcitabine 1000 mg/m2 plus cisplatin 25 mg/m2on days 1 and 8, administered every 3 weeks. All adverse events occurring during the first 180 days of GC were evaluated according to CTCAE, version 4.0. Results: A total of 151 pts, including 55 pts with rBTC and 96 pts with uBTC, were enrolled. In regard to the baseline characteristics, no significant differences between the rBTC and uBTC groups were found in the gender distribution [male: 69% vs. 57%], age [median: 68 vs. 68], or ECOG performance status (PS) [PS0: 67%vs. 55%]. The distribution of the primary tumor site (intrahepatic bile duct [27% vs. 33%] / extrahepatic bile duct [45% vs. 20%] / gallbladder [20% vs. 44%] / ampulla [7% vs. 3%]) was unbalanced between the two groups ( p < 0.01). The overall survival (OS) was significantly longer in the rBTC group than that in the uBTC group [median 15.8 months vs. 10.0 months, p = 0.02], however, there was no significant difference in the progression-free survival [median 6.8 months vs. 5.8 months] between the two groups. Grade 3-4 neutropenia was more frequent in the rBTC group [69%] as compared to that in the uBTC group [44%, p < 0.01], whereas Grade 3-4 cholangitis was significantly less frequent in the rBTC [5%] group than that in the uBTC group [21%, p = 0.02]. Conclusions: The incidence of Grade 3-4 neutropenia developing during GC was significantly higher in the rBTC group as compared to that in the uBTC group.

Neutrophil/lymphocyte ratio (NLR) may predict prognostic factor with gemcitabine, cisplatin (GC) for patients with advanced biliary tract cancer.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 410-410
Author(s):  
Toru Otsuru ◽  
Daisuke Sakai ◽  
Akie Kimura ◽  
Chiaki Inagaki ◽  
Naohiro Nishida ◽  
...  
Keyword(s):  
Overall Survival ◽  
Survival Rate ◽  
Bile Duct ◽  
Prognostic Factor ◽  
Biliary Tract ◽  
Biliary Tract Cancer ◽  
Intrahepatic Bile Duct ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Tract Cancer

410 Background: There is little information available about prognostic markers of GC (gemcitabine, cisplatin) in patients with advanced biliary tract cancer (BTC). Neutrophil/lymphocyte ratio (NLR) in several cancers was might to be a prognostic factor associated with clinical outcomes, we examine NLR in patient with BTC underwent chemotherapy (GC). Methods: Retrospective chart review for consecutive patients who underwent GC for advanced BTC in our institute were performed. The patients who were enrolled in ongoing clinical trials were excluded. Gemcitabine and cisplatin were administered intravenously at doses of 1,000 or 25 mg/m2, on day one and eight, every three weeks. We divided these patients based on estimated NLR, and evaluated the clinicopathological factors and survival in the two groups (NLR ≥ 3 or < 3). Results: 57 patients from 2013 to 2017 were reviewed. 23 patients were in NLR ≥ 3 group and 34 patients were in NLR < 3 group. Patients characteristics were as follows; median age, 68 years old (range: 38-83) years: male 36 (63%); primary tumor lesion, intrahepatic bile duct 6 (10%)/extrahepatic bile duct 32 (56%)/gallbladder 18 (32%)/ampulla of vater 1 (2%); therapeutic purpose, palliative 50 (88%)/adjuvant 5 (8%)/neoadjuvant 2 (4%); PS, 0/1. Response rate of the patients who had measurable lesion according to RECIST v1.1 was 17% (8/46), and disease control rate was 70% (32/46). The progression-free survival rate between the two groups is not significantly different. Although, the median overall survival (OS) of NLR ≥ 3 group was 11.8 months, while OS of NLR < 3 group was 29.2 months. The overall survival rate in the NLR ≥ 3 group was significantly lower than that in the NLR < 3 group ( P = 0.0339). Conclusions: Our study confirmed that high NLR is associated with worse OS and PFS, and suggested it may be a predictive marker for GC chemotherapy in patients with BTC.

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