Neoplasms

Digestive System Diseases

Gland and Hormone Related Diseases

All Conditions

Symptoms and General Pathology

Rare Diseases

Pancreatic Neoplasms

Constriction, Pathologic

Gastrointestinal Neoplasms

Digestive System Neoplasms

Endocrine Gland Neoplasms

Gastrointestinal Diseases

Pancreatic Diseases

Endocrine System Diseases

Pathological Conditions, Anatomical

Pancreatic Cancer

ERCP (endoscopic retrograde cholangiopancreatography) and placement of a pancreatic duct stent

endoscopic retrograde cholangiopancreatography

ERCP

Covered Self-expandable Metal Stent

Leena Kylänpää, MD, PhD

Sini Vehviläinen, MD

Hanna Seppänen, MD, PhD

Outi Lindström, MD, PhD

Marianne Udd, MD, PhD

Johanna Louhimo, MD, PhD

Arto Kokkola, MD, PhD

Leena Kylänpää

Sini M Vehviläinen, MD

Patients with pancreatic cancer often suffer from chronic abdominal pain, weight loss and decreased quality of life. The patients also often need pancreatic enzyme supplements. In this prospective study the aim is to see whether patients undergoing palliative pancreatic duct drainage will experience less chronic abdominal pain and a higher quality of life than patients with the same diagnosis without the procedure. The study also investigates whether the nutritional state of the patients with palliative stents remains better than in the control group.

In this prospective study all patients have inoperable pancreatic cancer. In these patients the pancreatic tumor causes radiologically visible dilatation of the pancreatic duct proximally to the tumor with a minimum diameter of 6mm. Patients also suffer from chronic abdominal pain caused by pancreatic cancer. The strength of the pain the patients are experiencing is evaluated with visual analogue scale (VAS). Patients in this study report experiencing chronic abdominal pain at least the strength of VAS 4 at the time of recruitment.

In this pilot study a total of 40 patients are recruited. Patients are divided into to two 20 patient groups. First group will receive a pancreatic duct stent followed by pain medication if needed and the control group will go with conventional pain relief methods only. All patients are asked to evaluate the strength of experienced pain with visual analogue scale at the time of recruitment, and then every 4 weeks up to 24 weeks. The patients will also be asked to evaluate their quality of life with a standardized EORTC-QLQ C30 version 3 quality of life questionnaire at the time of recruitment and then every 4 weeks up to 24 weeks. The patients are also asked to report their body weight, and the amount of pancreatic enzyme supplements needed at every point of survey.

Palliative Pancreatic Duct Stenting in Patients With Inoperable Pancreatic Cancer

The patients will be asked to evaluate their quality of life with a standardized EORTC-QLQ C30 version 3 questionnaire at the time of recruitment and then every 4 weeks up to 24 weeks.

Patients evaluate the strength of pain in visual analogue scale

Patients report their body weight in kilograms at every point of survey.

Patients report their need for pancreatic enzyme supplements at every point of survey

Helsinki University Central Hospital

MD, PhD

Cholangiocarcinoma

Adenocarcinoma

Adenoma

Cholangitis

Cholestasis

Bile Duct Diseases

Cholangitis, Sclerosing

Bile Duct Neoplasms

Adenoma, Bile Duct

Papilloma, Intraductal

Cholestasis, Extrahepatic

Carcinoma

Neoplasms, Glandular and Epithelial

Neoplasms by Histologic Type

Biliary Tract Diseases

Biliary Tract Neoplasms

Bile Duct Cancer

Primary Sclerosing Cholangitis

Experienced Endoscopists with significant user experience with Volumetric Laser Endomicroscopy for bile duct/pancreatic duct strictures

Experienced Endoscopists with non-significant or beignner user experience with Volumetric Laser Endomicroscopy for bile duct/pancreatic duct strictures

Interobserver agreement or Interrater agreement using 9 visual criteria for diagnosing VLE clips that feature indeterminate biliary or pancreatic duct strictures

Interobserver agreement or Interrater agreement

Michel Kahaleh, MD

The purpose of this study is to assess the interobserver agreement (IOV) for pancreatico-biliary Volumetric Laser Endomicroscopy (VLE) de-identified clips using the new VLE criteria.

This is an Interobserver study to validate VLE criteria for indeterminate biliary and pancreatic duct strictures and evaluate impact on clinical management.

Objective: Validate diagnostic impact of VLE diagnostic accuracy on clinical management

Primary Objectives:

1. Interobserver study for criteria validation and accuracy, Positive predictive value (PPV) and Negative predictive value (NPV), sensitivity and specificity.
2. Evaluation of VLE diagnostics on clinical management (increased accuracy/faster detection)
3. Determination of learning curve to standardize credentialing for endoscopists to use and interpret VLE imaging for biliary/pancreatic treatment management.

B. Hypotheses / Research Question(s) The new VLE criteria for biliary and pancreatic duct strictures increase accuracy, thus leading to substantial impact on clinical management (Screening and Treatment)

Study Design (2 phase):

* Phase 1: Primary Objective 1 and 2 part of the study will be completed.
* Phase 2: Primary Objective 3 of the study will be conducted within 1 month.

Study Timeline: 3 months post WIRB approval. Sample size: 40 VLE Clips of at least 20 seconds featuring one or more the VLE criteria. All clips will have confirmed diagnosis for accuracy analysis. All clips will be de-identified. All clips will be removed from RedCAP and other secure cloud storage upon completion of study.

Clips will be supplied by NinePoint Medical, the company behind VLE OCT. All VLE clips will be from a dataset of clips collected from adults \> 18 and who underwent Endoscopic retrograde cholangiopancreatography (ERCP) with indeterminate biliary stricture indications. The clips are chosen based on the quality of the clips, duration, final diagnosis and presence of either benign or malignant criteria.

Investigators: Up to 30 Expert and non-expert endoscopists currently using VLE

Volumetric Laser Endomicroscopy's (VLE) Diagnostic Accuracy Validation Study: Impact on Clinical Management Study

Interobserver study for criteria validation and accuracy, PPV and NPV, sensitivity and specificity

Correlation analysis of any of the 9 visual criteria with malignancy diagnosis as determined by endoscopist

Learning curve using CUSUM analysis to standardize credentialing for endoscopists to use and interpret VLE imaging for biliary/pancreatic treatment management proficiently.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization	Link
Palliative Pancreatic Duct Stenting in Patients With Inoperable Pancreatic Cancer	NCT03069664	Pancreatic Canc... Pancreatic Duct...	ERCP Covered Self-ex...	18 Years -	Helsinki University Central Hospital
Volumetric Laser Endomicroscopy's (VLE) Diagnostic Accuracy Validation Study: Impact on Clinical Management Study	NCT03951324	Biliary Strictu... Pancreas Cancer Cholangiocarcin... Bile Duct Cance... Bile Duct Neopl... Bile Duct Neopl... Bile Duct Lesio... Bile Duct Obstr... Bile Duct Disea... Bile Duct Obstr... Bile Duct Steno... Bile Duct Adeno... Pancreatic Duct... Pancreatic Duct... Pancreatic Duct... Pancreatic Duct... Primary Scleros...	Interobserver a...	18 Years -	Innovative Digestive Health Education and Research Inc

Spots Global Cancer Trial Database for pancreatic duct stricture