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Diagnostics
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Endoscopic Diagnostics for Pancreatobiliary Disorders
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Endoscopic Diagnostics for Pancreatobiliary Disorders

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging and Theranostics".

Deadline for manuscript submissions: closed (28 February 2020) | Viewed by 32505

Special Issue Editors

Dr. Masataka Kikuyama

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Guest Editor
Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-ku, Tokyo 113-8677, Japan
Interests: imaging diagnosis of early-stage pancreatic cancer; including carcinoma in situ; imaging diagnosis of biliary diseases
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Masayuki Kitano

E-Mail
Guest Editor
Deparment of Gastroenterology, Wakayama Medical University, Wakayama 641-8509, Japan
Interests: EUS; CE-EUS; EUS-FNA; pancreatic cancer; early diagnosis; IPMN
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Endoscopic diagnostics for gastrointestinal cancer have greatly advanced with the advancement of endoscopic apparatus and improved the prognosis of patients with gastrointestinal cancer. On the other hand, for pancreatobiliary disorders, including cancer, they are only now developing, and the prognosis of pancreatic cancer remains very poor. To diagnose pancreatobiliary disorders, radiologic methods such as CT or MRI have been the main ones used despite their limitations, while endoscopic ultrasonography (EUS) or endoscopic retrograde pancreatocholangiography (ERCP) have begun to play a role through newly developed methods, for example, EUS–fine needle aspiration (EUS-FNA) or serial pancreatic-juice aspiration cytologic examination (SPACE). The aim of this Special Issue is to clarify the role played for diagnosing pancreatobiliary disorders through endoscopic methods.

Dr. Masataka Kikuyama
Prof. Masayuki Kitano
Guest Editors

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Keywords

  • Endoscopic ultrasonography
  • Endoscopic retrograde cholangiopancreatography
  • EUS–FNA
  • SPACE
  • Pancreatic cancer
  • Bile-duct caner
  • Gallbladder cancer

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Published Papers (6 papers)

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Research

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9 pages, 868 KiB  
Article
Utility of Contrast-Enhanced Harmonic Endoscopic Ultrasonography for Early Diagnosis of Small Pancreatic Cancer
by Yasunobu Yamashita, Kensuke Tanioka, Yuki Kawaji, Takashi Tamura, Junya Nuta, Keiichi Hatamaru, Masahiro Itonaga, Takeichi Yoshida, Yoshiyuki Ida, Takao Maekita, Mikitaka Iguchi, Masaki Terada, Tetsuo Sonomura, Seiko Hirono, Ken-Ichi Okada, Manabu Kawai, Hiroki Yamaue and Masayuki Kitano
Diagnostics 2020, 10(1), 23; https://doi.org/10.3390/diagnostics10010023 - 1 Jan 2020
Cited by 18 | Viewed by 3716
Abstract
This study aimed to assess whether contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS), compared to multidetector-row computed tomography (MDCT) and magnetic resonance imaging (MRI), is useful for early diagnosis of small pancreatic cancer (PC). Between March 2010 and June 2018, all three imaging modalities and [...] Read more.
This study aimed to assess whether contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS), compared to multidetector-row computed tomography (MDCT) and magnetic resonance imaging (MRI), is useful for early diagnosis of small pancreatic cancer (PC). Between March 2010 and June 2018, all three imaging modalities and surgery were performed for patients with a pancreatic solid lesion measuring ≤20 mm; diagnostic ability was compared among modalities. Fifty-one of 60 patients were diagnosed with PC (PC size in 41 patients: 11–20 mm; 10 patients: ≤10 mm). The sensitivity, specificity, and accuracy of CH-EUS, MDCT, and MRI for PC (11–20 mm) detection were 95%/83%/94%, 78%/83%/79%, and 73%/33%/68%, respectively. The diagnostic ability of CH-EUS was significantly superior compared with MDCT and MRI (p = 0.002 and p = 0.007, respectively). The sensitivity, specificity, and accuracy of CH-EUS, MDCT, and MRI for PC (≤10 mm) detection were 70%/100%/77%, 20%/100%/38%, and 50%/100%/62%, respectively. The diagnostic ability of CH-EUS tended to be superior to that of MDCT (p = 0.025). The sensitivity of MDCT for PC (≤10 mm) detection was significantly lower than that for PC (11–20 mm) detection (20% vs. 78%; p = 0.001). CH-EUS, compared to MDCT and MRI, is useful for diagnosing small PCs. Full article
(This article belongs to the Special Issue Endoscopic Diagnostics for Pancreatobiliary Disorders)
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Review

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15 pages, 2840 KiB  
Review
The Diagnostic Dilemma of Malignant Biliary Strictures
by Robert Dorrell, Swati Pawa, Yi Zhou, Neeraj Lalwani and Rishi Pawa
Diagnostics 2020, 10(5), 337; https://doi.org/10.3390/diagnostics10050337 - 25 May 2020
Cited by 25 | Viewed by 9054
Abstract
The differential diagnosis for biliary strictures is broad. However, the likelihood of malignancy is high. Determining the etiology of a biliary stricture requires a comprehensive physical exam, laboratory evaluation, imaging, and ultimately tissue acquisition. Even then, definitive diagnosis is elusive, and many strictures [...] Read more.
The differential diagnosis for biliary strictures is broad. However, the likelihood of malignancy is high. Determining the etiology of a biliary stricture requires a comprehensive physical exam, laboratory evaluation, imaging, and ultimately tissue acquisition. Even then, definitive diagnosis is elusive, and many strictures remain indeterminant in origin. This literary review examines the diagnostic dilemma of biliary strictures and presents innovations in both histochemical and endoscopic techniques that have increased the diagnostic power of differentiating benign and malignant strictures. The field of tissue biopsy is revolutionizing with the advent of free DNA mutation profiling, fluorescence in situ hybridization (FISH), and methionyl t-RNA synthetase 1 (MARS 1), which allow for greater testing sensitivity. Endoscopic ultrasound, endoscopic retrograde cholangiopancreatography (ERCP), cholangioscopy, confocal laser endomicroscopy, and intraductal ultrasound build upon existing endoscopic technology to better characterize strictures that would otherwise be indeterminate in etiology. This review uses recent literature to insert innovative technology into the traditional framework of diagnostic methods for malignant biliary strictures. Full article
(This article belongs to the Special Issue Endoscopic Diagnostics for Pancreatobiliary Disorders)
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10 pages, 3948 KiB  
Review
Role of Peroral Cholangioscopy in the Diagnosis of Primary Sclerosing Cholangitis
by Toshio Fujisawa, Mako Ushio, Sho Takahashi, Wataru Yamagata, Yusuke Takasaki, Akinori Suzuki, Yoshihiro Okawa, Kazushige Ochiai, Ko Tomishima, Shigeto Ishii, Hiroaki Saito and Hiroyuki Isayama
Diagnostics 2020, 10(5), 268; https://doi.org/10.3390/diagnostics10050268 - 29 Apr 2020
Cited by 7 | Viewed by 4637
Abstract
Primary sclerosing cholangitis (PSC) is characterized by idiopathic biliary stricture followed by progressive cholestasis and fibrosis. When diagnosing PSC, its differentiation from other types of sclerosing cholangitis and cholangiocarcinoma is necessary. The cholangioscopic findings of PSC have not been investigated sufficiently. PSC and [...] Read more.
Primary sclerosing cholangitis (PSC) is characterized by idiopathic biliary stricture followed by progressive cholestasis and fibrosis. When diagnosing PSC, its differentiation from other types of sclerosing cholangitis and cholangiocarcinoma is necessary. The cholangioscopic findings of PSC have not been investigated sufficiently. PSC and IgG4-related sclerosing cholangitis are difficult to distinguish by peroral cholangioscopy (POCS), but POCS is useful for excluding cholangiocarcinoma. POCS findings vary according to the condition and stage of disease. In the active phase, findings such as mucosal erythema, ulceration, fibrinous white exudate, and an irregular surface are observed and may reflect strong inflammation in the biliary epithelium. On the other hand, findings such as scarring, pseudodiverticula, and bile duct stenosis appear in the chronic phase and may reflect fibrosis and stenosis resulting from repeated inflammation. Observation of inside the bile duct by POCS might confirm the current PSC activity. Because POCS offers not only information regarding the diagnosis of PSC and PSC-associated cholangiocarcinoma but also the current statuses of biliary inflammation and stenosis, POCS could significantly contribute to the diagnosis and treatment of PSC once the characteristic findings of PSC are confirmed by future studies. Full article
(This article belongs to the Special Issue Endoscopic Diagnostics for Pancreatobiliary Disorders)
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8 pages, 221 KiB  
Review
Benign Biliary Strictures: A Systematic Review on Endoscopic Treatment Options
by May Y.W. Wong, Payal Saxena and Arthur J. Kaffes
Diagnostics 2020, 10(4), 221; https://doi.org/10.3390/diagnostics10040221 - 15 Apr 2020
Cited by 12 | Viewed by 4374
Abstract
Benign biliary strictures can be difficult to manage. Untreated biliary strictures can lead to complications, such as chronic cholestasis, jaundice, recurrent sepsis, and secondary biliary cirrhosis, which can have severe ramifications. The management landscape is constantly evolving, with the development of modifiable self-expandable [...] Read more.
Benign biliary strictures can be difficult to manage. Untreated biliary strictures can lead to complications, such as chronic cholestasis, jaundice, recurrent sepsis, and secondary biliary cirrhosis, which can have severe ramifications. The management landscape is constantly evolving, with the development of modifiable self-expandable metal stents and biodegradable stents. This review critically appraises current endoscopic treatment strategies, in particular focusing on the shortfalls, such as stent migration and stricture recurrence. It also proposes a treatment algorithm based on aetiologias and the location of the strictures. Full article
(This article belongs to the Special Issue Endoscopic Diagnostics for Pancreatobiliary Disorders)
11 pages, 1434 KiB  
Review
The Expansion of Cholangioscopy: Established and Investigational Uses of SpyGlass in Biliary and Pancreatic Disorders
by Michael Yodice, Joseph Choma and Micheal Tadros
Diagnostics 2020, 10(3), 132; https://doi.org/10.3390/diagnostics10030132 - 29 Feb 2020
Cited by 34 | Viewed by 6509
Abstract
Direct visualization of bile and pancreatic duct pathology is proving to be beneficial in patients where previous techniques have failed. Recent advancements in technology and the development of the SpyGlass system have led to an increased use of cholangioscopy. It is already known [...] Read more.
Direct visualization of bile and pancreatic duct pathology is proving to be beneficial in patients where previous techniques have failed. Recent advancements in technology and the development of the SpyGlass system have led to an increased use of cholangioscopy. It is already known that SpyGlass is beneficial in patients with difficult bile duct stones and indeterminate biliary lesions through the use of targeted lithotripsy and visually guided biopsy. Cholangioscopy allows the visualization of hidden stone and guide wire placement across difficult strictures and selective cannulation of the intrahepatic and cystic ducts. It is also demonstrating its utility in investigational applications such as post-liver transplant and primary sclerosing cholangitis stricture treatment, evaluation of hemobilia, and guided radiofrequency ablation of ductal tumors. In addition to having clinical utility, cholangioscopy may also be cost-effective by limiting the number of repeat procedures. Cholangioscopy overall has similar complication rates compared to other standard endoscopic retrograde cholangioscopy (ERCP) techniques, but there may be higher rates of cholangitis. This could be mitigated with prophylactic antibiotic use, and overall, cholangioscopy has similar complication rates compared to other techniques. Full article
(This article belongs to the Special Issue Endoscopic Diagnostics for Pancreatobiliary Disorders)
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Other

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12 pages, 5353 KiB  
Case Report
A Pancreatic Inflammatory Myofibroblastic Tumor with Spontaneous Remission: A Case Report with a Literature Review
by Hiroyuki Matsubayashi, Katsuhiko Uesaka, Keiko Sasaki, Seitaro Shimada, Kazunori Takada, Hirotoshi Ishiwatari and Hiroyuki Ono
Diagnostics 2019, 9(4), 150; https://doi.org/10.3390/diagnostics9040150 - 17 Oct 2019
Cited by 10 | Viewed by 3650
Abstract
The inflammatory myofibroblastic tumor (IMT) is a rare tumor that can develop in any systemic organ. Its features are generally benign, but it often resembles malignancies and is treated surgically. Our patient was an 82-year-old female complaining of abdominal discomfort. Computed tomography demonstrated [...] Read more.
The inflammatory myofibroblastic tumor (IMT) is a rare tumor that can develop in any systemic organ. Its features are generally benign, but it often resembles malignancies and is treated surgically. Our patient was an 82-year-old female complaining of abdominal discomfort. Computed tomography demonstrated a 5 cm, ill-enhanced mass at the pancreas head. Upper gastrointestinal endoscopy revealed a duodenal submucosal tumor with apical erosion. Endoscopic ultrasonography (EUS) demonstrated a heterogeneous, low-echoic pancreas mass without clear margins. Fine-needle aspiration biopsy (FNAB) demonstrated spindle myofibroblastic tissues with lymphoplasmacyte and eosinophil infiltration, confirming an IMT diagnosis. Surprisingly, the tumor spontaneously regressed in one month without medication. Histological diagnosis using EUS-FNAB is essential for the rare pancreatic solid tumor like IMT. Full article
(This article belongs to the Special Issue Endoscopic Diagnostics for Pancreatobiliary Disorders)
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