title: Preoperative assessment of longitudinal extension of cholangiocarcinoma with peroral video-cholangioscopy: a prospective study.
abstract: OBJECTIVE
  Preoperative assessment of longitudinal extension of cholangiocarcinoma (CCA) is essential for making decisions concerning surgical resection and selecting operative procedures. We evaluated the accuracy of peroral video-cholangioscopy (PVCS) in diagnosing longitudinal extension of CCA.
  
  
  METHODS
  Patients with CCA who underwent preoperative PVCS were considered for this study. We evaluated the accuracy of PVCS in diagnosing longitudinal extension of perihilar cholangiocarcinoma (PCCA) and distal extrahepatic cholangiocarcinoma (DCCA) to the secondary biliary radicles and confluence of the hepatic ducts, respectively, on the hepatic side and to the intrapancreatic common bile duct on the papillary side. Diagnostic accuracy was determined by comparing the results with those of histopathological analyses of surgical specimens.
  
  
  RESULTS
  Forty-three consecutive patients were enrolled. The cholangioscope could not be advanced into the hepatic side in eight of the 25 patients with PCCA and in five of the 18 patients with DCCA. The accuracy of PVCS in diagnosing longitudinal extension of CCA on the hepatic and papillary sides was 82.4% and 92.0%, respectively, in patients with PCCA and 92.3% and 100%, respectively, in patients with DCCA. PVCS accurately detected longitudinal extension of CCA to the hepatic and papillary sides that was not detected previously by endoscopic retrograde cholangiography in 20.0% and 11.6% patients, respectively.
  
  
  CONCLUSIONS
  PVCS proved useful for the preoperative assessment of longitudinal extension of CCA. Therefore, it can aid surgeons in deciding surgical resectability and selecting operative procedures. This, in turn, may impact overall patient prognosis.
authors: Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors: Takao
authors: T
authors: Nishikawa
authors: Toshio
authors: T
authors: Tsuyuguchi
authors: Yuji
authors: Y
authors: Sakai
authors: Harutoshi
authors: H
authors: Sugiyama
authors: Takashi
authors: T
authors: Kishimoto
authors: Masayuki
authors: M
authors: Ohtsuka
authors: Masaru
authors: M
authors: Miyazaki
authors: Osamu
authors: O
authors: Yokosuka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D001653:Bile Ducts, Intrahepatic; D001662:Biliary Tract Surgical Procedures / Q000379:methods; D018281:Cholangiocarcinoma / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D002758:Cholangiography / Q000379:methods; D015331:Cohort Studies; D003287:Contrast Media; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D011856:Radiographic Image Enhancement; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods; D014741:Video Recording
chemical_list: D003287:Contrast Media
keywords: biliary tract; biopsy; cholangiocarcinoma; endoscopy; narrow-band imaging