Cholangiocarcinoma is a malignancy arising from the epithelial lining of the intrahepatic or extrahepatic biliary tract. Timely diagnosis is challenging due to its silent clinical course. As reliable laboratory markers are lacking, diagnostic imaging plays a pivotal role. While cross-sectional imaging studies are usually conclusive for intrahepatic lesions, endoscopy plays an essential role in cases of extrahepatic tumors. Rational utilization of different diagnostic methods based on available evidence is needed. This article focuses on the diagnostic role of advanced biliary endoscopy, including endoscopic retrograde cholangiopancreatography, cholangioscopy, endoscopic ultrasonography, and intraductal sonography.
- Publication type
- Journal Article MeSH
- Review MeSH
- MeSH
- Biopsy MeSH
- Cholangiopancreatography, Endoscopic Retrograde * methods MeSH
- Cholangitis MeSH
- Humans MeSH
- Lithotripsy methods MeSH
- Adenocarcinoma, Mucinous diagnosis surgery MeSH
- Pancreatic Neoplasms diagnosis surgery MeSH
- Bile Duct Diseases diagnosis pathology therapy MeSH
- Pancreatitis MeSH
- Carcinoma, Papillary diagnosis surgery MeSH
- Practice Guidelines as Topic MeSH
- Check Tag
- Humans MeSH
- Publication type
- Meeting Abstract MeSH
AIM: Water-aided insertion as an alternative colonoscopy technique reduces patient discomfort. Warm water has been used in most published trials, but the use of cool water is easier and, if equally effective, could support the use of the water-aided technique in routine practice. METHOD: A double-blind, randomized, single-centre study was performed in which 201 patients were randomized to either cool (20-24 °C) or warm (37 °C) water immersion insertion. The primary outcome was caecal intubation time. The success rate of minimal sedation and patient discomfort were also assessed. RESULTS: The caecal intubation time for cool and warm water was similar (6.9 ± 3.5 vs 7.0 ± 3.4 min, P = 0.64). The respective success rates of minimal sedation colonoscopy (89.1% vs 90%, P = 1.00) and discomfort (P = 0.51) were no different. All other outcomes except a greater need for abdominal compression in the cool water arm (P = 0.04) were similar including the total procedure time, terminal ileum intubation rate, adenoma detection, length of the inserted scope, water volume, non-standard position rate, difficulty of the procedure and the patient's temperature sensation. CONCLUSION: The use of cool water did not modify the caecal intubation time compared with warm water. Exception for abdominal compression, all other end-points were no different. Cool water immersion is an alternative to the technically more demanding warm water immersion colonoscopy.
- MeSH
- Abdominal Pain etiology MeSH
- Time Factors MeSH
- Cecum MeSH
- Operative Time MeSH
- Adult MeSH
- Double-Blind Method MeSH
- Hypnotics and Sedatives administration & dosage MeSH
- Catheterization * MeSH
- Colonoscopy adverse effects methods MeSH
- Middle Aged MeSH
- Humans MeSH
- Aged MeSH
- Temperature * MeSH
- Water MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Randomized Controlled Trial MeSH
