Novel biomarkers and endoscopic techniques for diagnosing pancreaticobiliary malignancy

Abstract

The UK incidence of pancreatic ductal adenocarcinoma is 9 per 100,000 population, and biliary tract cancer occurs at a rate of 1-2 per 100,000. The incidence of both cancers is increasing annually and these tumours continue to be diagnosed late and at an advanced stage, limiting options for curative treatment. Population-based screening programmes do not exist for these cancers, and diagnosis currently is dependent on symptom recognition, but often symptoms are not present until the disease is advanced. Recently, a number of promising blood and urine biomarkers have been described for pancreaticobiliary malignancy and are summarised in this review. Novel endoscopic techniques such as single-operator cholangioscopy and confocal endomicroscopy have been used in some centres to enhance standard endoscopic diagnostic techniques and are also evaluated in this review.

Keywords: CA 19-9; Endoscopic retrograde; Pancreaticobiliary malignancy; biliary; cholangiopancreatography; pancreatic.

Figure 1.. Novel diagnostic adjuncts to ERCP and EUS.

( a) Cholangioscopic view of a malignant hilar stricture with visualisation of the ulcerated, friable biliary mucosa via the Spyglass cholangioscope system (Boston Scientific Corp, Massachusetts, USA). ( b) Confocal endomicroscopic image of pancreatic cancer, showing characteristic black clumps. Image was obtained using the Cellvizio AQ-Flex® probe which was introduced to the tumour via 19G FNA needle at the time of EUS.