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

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.

 

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Conflicts of interest

M.J. Bruno received research funding for industry initiated studies from Boston Scientific and Cook Medical. He received research funding for investigator initiated studies from Boston Scientific, Cook Medical, Pentax Medical, Interscope, Mylan and ChiRoStim. He is a consultant to Boston Scientific, Cook Medical, and Pentax Medical. J.E. van Hooft received research funding for investigator initiated studies from Cook Medical. She is a consultant to Boston Scientific, Olympus, Medtronic and Abbvie. The remaining authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.

Publication History

Article published online:
14 April 2023