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Identification of Pancreatic Cancer in Biliary Obstruction Patients by FRY Site-specific Methylation
Angsuwatcharakon, Phonthep,Rerknimitr, Rungsun,Kongkam, Pradermchai,Ridtitid, Wiriyaporn,Ponauthai, Yuwadee,Srisuttee, Ratakorn,Kitkumthorn, Nakarin,Mutirangura, Apiwat Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.9
Background: Methylation at cg 16941656 of FRY is exclusively found in normal pancreatic tissue and has been proven to be specific for pancreatic-in-origin among several adenocarcinomas. Here, we investigated methylated DNA in the bile as a biomarker to differentiate the cause of obstruction between pancreatic cancer and benign causes. Materials and Methods: Bile samples of 45 patients with obstructive jaundice who underwent ERCP were collected and classified into pancreatic cancer (group 1) and benign causes (group 2) in 24 and 21 patients, respectively. DNA was extracted from bile and bisulfite modification was performed. After, methylation in cg 16941656 of FRY was identified by real-time PCR, with beta-actin used as a positive control. Results: Methylated DNA was identified in 10/24 (41.67%) and 1/21 (4.8%) of cases in groups 1 and 2, respectively (P= 0.012). The sensitivity, specificity, positive predictive value and negative predictive value to differentiate pancreatic cancer from benign causes were 42%, 95%, 91%, and 59%, respectively. Conclusions: Detecting a methylation at cg 16941656 of FRY in bile has high specificity, with an acceptable positive likelihood rate, and may therefore be helpful in distinguish pancreatic cancer from benign strictures.
Cracking Difficult Biliary Stones
Phonthep Angsuwatcharakon,Rungsun Rerknimitr 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.5
Apart from difficult biliary cannulation, biliary stone removal is considered one of the hurdles in endoscopic retrogradecholangiopancreatography. Generally, simple common bile duct (CBD) stones can be removed either with an extraction balloon or abasket. However, there are difficult stones that cannot be removed using these standard methods. The most difficult stones are largeCBD stones and impacted stones in a tapering CBD. A few decades ago, mechanical lithotripsy was usually required to manage thesestones. At present, endoscopic papillary large balloon dilation (EPLBD) of the biliary orifice has become the gold standard for largeCBD stones up to 1.5 cm. EPLBD can reduce the procedural time by shortening the stone removal process. It can also save the costof the devices, especially multiple baskets, used in mechanical lithotripsy. Unfortunately, very large CBD stones, stones impacted ina tapering CBD, and some intrahepatic duct stones still require lithotripsy. Peroral cholangioscopy provides direct visualization ofthe stone, which helps the endoscopist perform a probe-based lithotripsy either with an electrohydraulic probe or a laser probe. Thistechnique can facilitate the management of difficult CBD stones with a high success rate and save procedural time without significanttechnical complications.
Wiriyaporn Ridtitid,Thanawat Luangsukrerk,Panida Piyachaturawat,Nicha Teeratorn,Phonthep Angsuwatcharakon,Pradermchai Kongkam,Rungsun Rerknimitr 한국간담췌외과학회 2022 Annals of hepato-biliary-pancreatic surgery Vol.26 No.1
Backgrounds/Aims: In moderate and high-surgical risk patients with acute cholecystitis, studies comparing percutaneous cholecystostomy (PC) vs. endoscopic transpapillary gallbladder stenting (ETGS) vs. endoscopic ultrasound-guided transmural gallbladder stenting (EUGS) are limited. Thus, the aim of this study was to compare efficacy and recurrence of cholecystitis after PC, ETGS, or EUGS during follow-up. Methods: We reviewed 143 moderate and high-surgical risk patients with acute cholecystitis with or without concomitant common bile duct stones who underwent PC, ETGS, or EUGS at our hospital. Technical success rate (TSR), clinical success rate (CSR), and recurrence were compared. Results: TSR in PC or EUGS group was higher than that in the ETGS group for those with concomitant common bile duct stones (100% vs. 100% vs. 73.2%; p = 0.07) and for those without concomitant common bile duct stones (100% vs. 100% vs. 77.3%; p < 0.001). CSR in ETGS or EUGS group was higher than that in the PC group for those with concomitant common bile duct stones (96.2% vs. 100% vs. 87.5%; p = 0.41) and for those without concomitant common bile duct stones (94.1% vs. 100% vs. 63.0%; p = 0.006). Using Kaplan–Meier analysis, the overall recurrent risk was the highest in the PC group (p = 0.004). Conclusions: In moderate and high-surgical risk patients with acute cholecystitis, EUGS provides significantly higher CSR with comparable TSR to PC. Thus, ETGS should be the first choice in those with concomitant common bile duct stones. Among the three patient groups, those who received PC had the highest rate of recurrence.