Impact of Endoscopic Ultrasound in Unresectable Perihilar Cholangiocarcinoma patients in Liver Transplantation work-up

D. M. de Jong; C. Den Hoed; F. Willemssen; M.G. J. Thomeer; M. J. Bruno; B. Groot Koerkamp; J. De Jonge; I.P. J. Alwayn; J. E. Van Hooft; F. Hoogwater; F. Van Der Heide; A. Inderson; F.G. I. Van Vilsteren; L.M.J. W. Van Driel

doi:10.1055/s-0043-1765209

Endoscopy, Table of Contents

Endoscopy 2023; 55(S 02): S90
DOI: 10.1055/s-0043-1765209

Abstracts | ESGE Days 2023

Oral presentation

Complex biliary problems in liver transplant patients 22/04/2023, 08:30 – 09:30 Ecocem

Impact of Endoscopic Ultrasound in Unresectable Perihilar Cholangiocarcinoma patients in Liver Transplantation work-up

Authors

D. M. de Jong

¹Erasmus University Medical Center, Department of Gastroenterology and Hepatology, Rotterdam, Netherlands
C. Den Hoed

¹Erasmus University Medical Center, Department of Gastroenterology and Hepatology, Rotterdam, Netherlands

²Erasmus MC Transplant Institute, Rotterdam, Netherlands
F. Willemssen

³Erasmus University Medical Center, Department of Radiology and Nucleair Medicine, Rotterdam, Netherlands
M.G. J. Thomeer

³Erasmus University Medical Center, Department of Radiology and Nucleair Medicine, Rotterdam, Netherlands
M. J. Bruno

¹Erasmus University Medical Center, Department of Gastroenterology and Hepatology, Rotterdam, Netherlands
B. Groot Koerkamp

⁴Erasmus University Medical Center, Department of Surgery, Rotterdam, Netherlands
J. De Jonge

⁴Erasmus University Medical Center, Department of Surgery, Rotterdam, Netherlands
I.P. J. Alwayn

⁵Leiden University Medical Center, Department of Surgery, Leiden, Netherlands
J. E. Van Hooft

⁶Leiden University Medical Center, Department of Gastroenterology and Hepatology, Leiden, Netherlands
F. Hoogwater

⁷University Medical Center Groningen, Department of HPB Surgery and Liver Transplantation, Groningen, Netherlands
F. Van Der Heide

⁸University Medical Center Groningen, Department of Gastroenterology and Hepatology, Groningen, Netherlands
A. Inderson

⁶Leiden University Medical Center, Department of Gastroenterology and Hepatology, Leiden, Netherlands
F.G. I. Van Vilsteren

⁸University Medical Center Groningen, Department of Gastroenterology and Hepatology, Groningen, Netherlands
L.M.J. W. Van Driel

¹Erasmus University Medical Center, Department of Gastroenterology and Hepatology, Rotterdam, Netherlands

Abstract

Full Text

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 lymph node (LN) assessment by endoscopic ultrasound (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 2010-2021. During EUS, sampling of a ‘suspicious’ LN was performed based on the endosonographist’s discretion. The primary outcome was the added value of EUS, defined as number of patients who were precluded from further screening due to malignant LN ([Table 1]).

Table 1

Results In 75 patients (characteristics in Table) a total of 84 EUS procedures were performed. In 18 patients (24%), 31 suspicious non-regional LN were identified with tissue acquisition in 28 (90%). In two patients LN biopsy confirmed malignancy and further screening was precluded. Finally, 44 (59%) underwent surgical staging and positive LN were identified in 6 patients (14%). In an additional 6 patients (21%) positive regional LN were identified in the liver explant.

Conclusions Our current EUS screening for the detection of malignant LN in patients with pCCA eligible for LT shows a limited but clinically important yield. EUS with systematic screening of all LN stations and sampling of ‘suspicious’ lymph nodes according to defined and set criteria (size, shape, homogeneity, etc) could potentially increase this yield.

Figures

Table 1