Definition of age-dependent reference values for the diameter of the common bile duct and pancreatic duct on MRCP: a population-based, cross-sectional cohort study

Beyer, Georg; Kasprowicz, Florian; Hannemann, Anke; Aghdassi, Ali; Thamm, Patrick; Völzke, Henry; Lerch, Markus M.; Kühn, Jens‐Peter; Mayerle, Julia

doi:10.1136/gutjnl-2021-326106

Cited by 23 publications

(10 citation statements)

References 43 publications

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“…For patients undergoing ERCP procedure, the positions of the major papilla and DHJ may not be routinely recorded, resulting in an underestimation of the proportion of HDP. MRCP, as a non-invasive imaging technique, is widely used to depict the natural state of the CBD, PD, and duodenum simultaneously [ 19 ]. It is not affected by surgical or endoscopic manipulations.…”

Section: Discussionmentioning

confidence: 99%

Horizontal duodenal papilla is associated with a special spectrum of pancreaticobiliary diseases: a retrospective magnetic resonance cholangiopancreatography-based study

Zhang,

Shi,

et al. 2023

Gastroenterology Report

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Background Horizontal duodenal papilla (HDP) is not an uncommon ectopic major papilla. The impact of HDP on the occurrence of pancreaticobiliary diseases remains unclear. Here, we explored the associations in patients who underwent magnetic resonance cholangiopancreatography (MRCP). Methods Consecutive patients who underwent MRCP at Xijing Hospital (Xi’an, China) between January 2020 and December 2021 were eligible. Patients were divided into HDP and regular papilla (RP) according to the position of the major papilla. The primary outcome was the proportion of congenital pancreaticobiliary diseases. Results A total of 2,194 patients were included, of whom 72 (3.3%) had HDP. Compared with the RP group (n = 2,122), the HDP group had a higher proportion of congenital pancreaticobiliary diseases, especially choledochal cyst (CC) or anomalous pancreaticobiliary junction (APBJ) (6.9% vs 1.4%, P = 0.001). More gallbladder cancer (6.9% vs 1.2%, P < 0.001) and pancreatic cysts (27.8% vs 16.3%, P = 0.01) were also identified in the HDP group. Morphologically, the HDP group had a longer extrahepatic bile duct (8.4 [7.6–9.3] cm vs 7.2 [6.5–8.1] cm, P < 0.001), and larger angles between the common bile duct-duodenum and pancreatic duct-duodenum. Multivariate analysis showed that the presence of HDP was an independent risk factor for gallbladder cancer. Conclusions This study confirmed that HDP was not rare in patients underwent MRCP. A higher prevalence of congenital pancreaticobiliary malformations (especially CC or APBJ), gallbladder cancer and pancreatic cysts was observed in patients with HDP, as well as distinctive morphologic features.

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Section: Discussionmentioning

confidence: 99%

Horizontal duodenal papilla is associated with a special spectrum of pancreaticobiliary diseases: a retrospective magnetic resonance cholangiopancreatography-based study

Zhang,

Shi,

et al. 2023

Gastroenterology Report

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“…Owing to direct compression, dCCA shows abrupt biliary tree cutoff from CT scanning while pCCA can be obvious only when dilated segmental bile ducts emerge ( 28 ). MRI can delineate the biliary tree with its lesions in detail and allow accurate ducts depicted by magnetic resonance cholangiopancreatography (MRCP) which is critical for the diagnosis, staging, and treatment planning of pCCA ( 29 ). MRI illustrates CCA as hypointense lesions and heterogeneously hyperintense lesions on T1-weighted images and T2-weighted images, respectively ( 30 ).…”

Section: Clinical Symptoms and Diagnosis Early To Arisementioning

confidence: 99%

An overview of extrahepatic cholangiocarcinoma: from here to where?

Yang

Zhang

2023

Front. Oncol.

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Extrahepatic cholangiocarcinoma (eCCA) contains perihilar cholangiocarcinoma and distal cholangiocarcinoma both of which can arise at any point of the biliary tree and originate from disparate anatomical sites. Generally, the incidence of eCCA is increasing globally. Though surgical resection is the principal treatment of choice for the early stages of eCCA, optimal survival remains restricted by the high risk of recurrence when most patients are present with unresectable disease or distant metastasis. Furthermore, both intra- and intertumoral heterogeneity make it laborious to determine molecularly targeted therapies. In this review, we mainly focused on current findings in the field of eCCA, mostly including epidemiology, genomic abnormalities, molecular pathogenesis, tumor microenvironment, and other details while a summary of the biological mechanisms driving eCCA may shed light on intricate tumorigenesis and feasible treatment strategies.

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“…We however aim to expand this proof-of-concept study by including additional data. For example by use of age-adjusted upper limit for common bile duct dilation, rather than a single cut-off of 6mm [23]. Additional model validation in independent cohorts will be important to improve validity of our approach.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

A machine learning-based choledocholithiasis prediction tool to improve ERCP decision making: a proof-of-concept study

Steinway,

Tang,

Caffo

et al. 2023

Endoscopy

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Background: Prior studies have demonstrated that existing guidelines to predict choledocholithiasis have limited accuracy, leading to overutilization of ERCP. Improved stratification may allow for appropriate patient selection for ERCP and the use of lower-risk modalities (i.e. EUS and MRCP). Methods: A machine learning model was developed using patient information from two published cohort studies originally used to evaluate performance of published guidelines in predicting choledocholithiasis. Prediction models were developed using the gradient boosting (GBM) machine learning method. GBM performance was evaluated using 10-fold cross-validation and area under the receiver operating curve (AUC). Important predictors of choledocholithiasis were identified based on relative importance in GBM. Results: 1,378 patients (mean age 43.3 years; 55.5% females) were included in the GBM model and 59.4% had choledocholithiasis. Eight variables were identified as predictors of choledocholithiasis. The GBM model was evaluated with 10-fold cross-validation and had an accuracy of 71.5±2.5% (AUC 0.79±0.06) and performed better than the 2019 ASGE guidelines (accuracy 62.4±2.6%, AUC 0.63±0.03) and the ESGE guidelines (accuracy 62.8±2.6%, AUC 0.67±0.02). The GBM model correctly categorized 22% of patients directed to unnecessary ERCP by the ASGE guidelines and appropriately recommended 48% of ERCPs incorrectly rejected by the ESGE guidelines as the next step in the management. Conclusions: A machine learning-based tool was created that provides a real-time, personalized, objective probability of choledocholithiasis and ERCP recommendations. This more accurately directs ERCP use than the existing ASGE and ESGE guidelines and has the potential to reduce morbidity and healthcare costs associated with ERCP or missed choledocholithiasis.

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Definition of age-dependent reference values for the diameter of the common bile duct and pancreatic duct on MRCP: a population-based, cross-sectional cohort study

Cited by 23 publications

References 43 publications

Horizontal duodenal papilla is associated with a special spectrum of pancreaticobiliary diseases: a retrospective magnetic resonance cholangiopancreatography-based study

Horizontal duodenal papilla is associated with a special spectrum of pancreaticobiliary diseases: a retrospective magnetic resonance cholangiopancreatography-based study

An overview of extrahepatic cholangiocarcinoma: from here to where?

A machine learning-based choledocholithiasis prediction tool to improve ERCP decision making: a proof-of-concept study

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