Role of endoscopy in the management of primary sclerosing cholangitis

Marya, Neil B.; Tabibian, James H.

doi:10.4253/wjge.v11.i2.84

Cited by 3 publications

(3 citation statements)

References 58 publications

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“…Diagnostic and surveillance challenges posed by indeterminate biliary strictures, especially in PSC patients, are well known [18,19]. In the current study, bimodal ERCP unveiled a dominant segmental stricture in a patient with PSC, not otherwise seen on conventional fluoroscopy.…”

Section: Discussionsupporting

confidence: 48%

Bimodal ERCP, a new way of seeing things

et al. 2020

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Background and study aims Conventional endoscopic retrograde cholangiopancreatography (ERCP) is hampered by two-dimensional visualization, post-procedural adverse events (AEs), and exposure to ionizing radiation. Bimodal ERCP might mitigate these challenges, but no reports of its use are available to date. The aim of this study was to explore the feasibility of bimodal ERCP, while investigating its potential clinical yield. Patients and methods This was a retrospective observational study of patients that underwent bimodal ERCP in a single tertiary academic referral center. Thirteen patients undergoing conventional ERCP had a previously T2-weighted isotropic 3 D TSE MRCP sequence aligned and fused with the two-dimensional image generated from the fluoroscopy c-arm unit in real time. Results Over a 2-month period, 13 patients with a mean age of 54 underwent bimodal ERCP for bile duct stricture (61.5 %), complex cholelithiasis (7.7 %) and ductal leakage (30.1 %). Bimodal ERCP was feasible in all 13 cases, and image quality was assessed as “good” in 11 patients (84.6 %). Bimodal ERCP aided in visualizing the lesion of interest (76.9 %), assisted in understanding the 3 D anatomy of the biliopancreatic ductal system (61.5 %), and aided in finding a favorable position for the c-arm (38.4 %) for subsequent therapeutic intervention. Conclusions This first report on bimodal ERCP proves its feasibility and suggests that it may assist in increasing both the diagnostic and therapeutic yield of ERCP, while at the same time decreasing AEs during and after ERCP. Its main application might lie in treatment of complex intrahepatic disease.

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Section: Discussionsupporting

confidence: 48%

Bimodal ERCP, a new way of seeing things

et al. 2020

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“…An earlier study performed by Savader, Prescott, Lund and Osterman on intraductal biliary biopsy concluded that brush cytology and fluoroscopy guided forceps had zero sensitivity for diagnosing bile duct cancer (cholangiocarcinoma), while sensitivity increased to 27% when using direct optical imaging of forceps within the bile duct [8] . More recently a custom single-operator cholangioscope that provides this direct optical imaging and a smaller-sized forceps system were developed, and sensitivity has been improved to be greater than brush biopsy [2] , [9] , [10] . The advent of second generation cholangioscopes and laser-based imaging catheters may provide greater improvements in sensitivity and specificity but have not provided satisfactory diagnostic yield of tissue during cholangiopancretoscopy, which may be addressed with new innovative biopsy tools [11] , [12] .…”

Section: Introductionmentioning

confidence: 99%

Intraductal Tissue Sampling Device Designed for the Biliary Tract

Patel

Carson

Seibel

et al. 2021

IEEE J. Transl. Eng. Health Med.

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Clinical sampling of tissue that is read by a pathologist is currently the gold standard for making a disease diagnosis, but the few minimally invasive techniques available for small duct biopsies have low sensitivity, increasing the likelihood of false negative diagnoses. We propose a novel biopsy device designed to accurately sample tissue in a biliary stricture under fluoroscopy or endoscopic guidance. The device consists of thin blades organized around the circumference of a cylinder that are deployed into a cutting annulus capable of comprehensively sampling tissue from a stricture. A parametric study of the device performance was done using finite element analysis; this includes the blade deployment under combined axial compression and torsion followed by an axial ‘cutting’ step. The clinical feasibility of the device is determined by considering maximum deployment forces, the radial expansion achieved and the cutting stiffness. We find practical parameters for the device operation to be an overall length of 10 mm and a diameter of 3.5 mm for a \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{upgreek} \usepackage{mathrsfs} \setlength{\oddsidemargin}{-69pt} \begin{document} }{}$50~\mu \text{m}$ \end{document} blade thickness, which allow the device to be safely deployed with a force of 10N and achieve an expansion over 3x its original diameter. A model device was fabricated with these parameters and a \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{upgreek} \usepackage{mathrsfs} \setlength{\oddsidemargin}{-69pt} \begin{document} }{}$75~\mu \text{m}$ \end{document} thickness out of a NiTi superalloy and tested to validate the performance. The device showed strong agreement with an equivalent numerical model, reaching a peak force within 2% of that predicted numerically and fully recovering after compression to 20% of its length. Clinical and Translational Impact Statement –This pre-clinical research conceptually demonstrates a novel expandable device to biopsy tissue in narrow strictures during an ERCP procedure. It can greatly improve diagnostic tissue yield compared to existing methods.

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“…Till now, cytotoxic chemotherapy remains the only therapeutic method for unresectable cholangiocarcinoma (CCA). Unfortunately, CCA resists most chemotherapy, and 5-year overall survival status is extremely poor, remaining at 10% 3,4 . To improve the diagnosis and prognosis of CCA patients, it is crucial to investigate molecular mechanisms to develop biological treatment.…”

Section: Introductionmentioning

confidence: 99%

miR-186 Suppresses the Progression of Cholangiocarcinoma Cells Through Inhibition of Twist1

2019

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Deregulation of miR-186 and Twist1 has been identified to be involved in the progression of multiple cancers. However, the detailed molecular mechanisms underlying miR-186-involved cholangiocarcinoma (CCA) are still unknown. In this study, we found that miR-186 was downregulated in CCA tissues and cell lines, and negatively correlated with the expression of Twist1 protein. In vitro assays demonstrated that miR-186 mimics repressed cell proliferation, in vivo tumor formation, and caused cell cycle arrest. miR-186 mimics also inhibited the migration and invasion of CCLP1 and SG-231 cells. Mechanistically, the 3′-untranslated region (3′-UTR) of Twist1 mRNA is a direct target of miR-186. Further, miR-186 inhibited the expressions of Twist1, N-cadherin, vimentin, and matrix metallopeptidase 9 (MMP9) proteins, whereas it increased the expression of E-cadherin in CCLP1 and SG-231 cells. Silencing of Twist1 expression enhanced the inhibitory effects of miR-186 on the proliferation, migration, and invasion of CCLP1 and SG-231 cells. In conclusion, miR-186 inhibited cell proliferation, migration, invasion, and epithelial‐mesenchymal transition (EMT) through targeting Twist1 in human CCA. Thus, miR-186/Twist1 axis may benefit the development of therapies for CCA.

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Role of endoscopy in the management of primary sclerosing cholangitis

Cited by 3 publications

References 58 publications

Bimodal ERCP, a new way of seeing things

Bimodal ERCP, a new way of seeing things

Intraductal Tissue Sampling Device Designed for the Biliary Tract

miR-186 Suppresses the Progression of Cholangiocarcinoma Cells Through Inhibition of Twist1

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