TY - JOUR
T1 - Impact of EUS in liver transplantation workup for patients with unresectable perihilar cholangiocarcinoma
AU - de Jong, David M.
AU - den Hoed, Caroline M.
AU - Willemssen, Francois E.J.A.
AU - Thomeer, Maarten G.J.
AU - Bruno, Marco J.
AU - Koerkamp, Bas Groot
AU - de Jonge, Jeroen
AU - Alwayn, Ian P.J.
AU - van Hooft, Jeanin E.
AU - Hoogwater, Frederik
AU - van der Heide, Frans
AU - Inderson, Akin
AU - van Vilsteren, Frederike G.I.
AU - van Driel, Lydi M.J.W.
N1 - Publisher Copyright:
© 2024 American Society for Gastrointestinal Endoscopy
PY - 2024/4
Y1 - 2024/4
N2 - Background and Aims: For a highly selected group of patients with unresectable perihilar cholangiocarcinoma (pCCA), liver transplantation (LT) is a treatment option. The Dutch screening protocol comprises nonregional lymph node (LN) assessment by EUS, and whenever LN metastases are identified, further LT screening is precluded. The aim of this study is to investigate the yield of EUS in patients with pCCA who are potentially eligible for LT. Methods: In this retrospective, nationwide cohort study, all consecutive patients with suspected unresectable pCCA who underwent EUS in the screening protocol for LT were included from 2011 to 2021. During EUS, sampling of a “suspicious” nonregional LN was performed based on the endoscopist's discretion. The primary outcome was the added value of EUS, defined as the number of patients who were precluded from further screening because of malignant LNs. Results: A total of 75 patients were included in whom 84 EUS procedures were performed, with EUS-guided tissue acquisition confirming malignancy in LNs in 3 of 75 (4%) patients. In the 43 who underwent surgical staging according to the protocol, nonregional LNs with malignancy were identified in 6 (14%) patients. Positive regional LNs were found in 7 patients in post-LT-resected specimens. Conclusions: Our current EUS screening for the detection of malignant LNs in patients with pCCA eligible for LT shows a limited but clinically important yield. EUS with systematic screening of all LN stations, both regional and nonregional, and the sampling of suspicious lymph nodes according to defined and set criteria could potentially increase this yield.
AB - Background and Aims: For a highly selected group of patients with unresectable perihilar cholangiocarcinoma (pCCA), liver transplantation (LT) is a treatment option. The Dutch screening protocol comprises nonregional lymph node (LN) assessment by EUS, and whenever LN metastases are identified, further LT screening is precluded. The aim of this study is to investigate the yield of EUS in patients with pCCA who are potentially eligible for LT. Methods: In this retrospective, nationwide cohort study, all consecutive patients with suspected unresectable pCCA who underwent EUS in the screening protocol for LT were included from 2011 to 2021. During EUS, sampling of a “suspicious” nonregional LN was performed based on the endoscopist's discretion. The primary outcome was the added value of EUS, defined as the number of patients who were precluded from further screening because of malignant LNs. Results: A total of 75 patients were included in whom 84 EUS procedures were performed, with EUS-guided tissue acquisition confirming malignancy in LNs in 3 of 75 (4%) patients. In the 43 who underwent surgical staging according to the protocol, nonregional LNs with malignancy were identified in 6 (14%) patients. Positive regional LNs were found in 7 patients in post-LT-resected specimens. Conclusions: Our current EUS screening for the detection of malignant LNs in patients with pCCA eligible for LT shows a limited but clinically important yield. EUS with systematic screening of all LN stations, both regional and nonregional, and the sampling of suspicious lymph nodes according to defined and set criteria could potentially increase this yield.
UR - http://www.scopus.com/inward/record.url?scp=85187838247&partnerID=8YFLogxK
U2 - 10.1016/j.gie.2023.10.047
DO - 10.1016/j.gie.2023.10.047
M3 - Article
C2 - 37890597
AN - SCOPUS:85187838247
SN - 0016-5107
VL - 99
SP - 548
EP - 556
JO - Gastrointestinal endoscopy
JF - Gastrointestinal endoscopy
IS - 4
ER -