Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Department of Medicine, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA; Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Gastrointest Endosc. 2017 Dec;86(6):1152-1156.e2. doi: 10.1016/j.gie.2017.02.026. Epub 2017 Mar 1.
Duodenal collections of pancreatic fluid can be used as a source of mutations and other markers of pancreatic ductal neoplasia, but admixing pancreatic juice with duodenal contents lowers the concentrations of mutations. Collecting pancreatic fluid directly from the ampulla could yield a purer sample of pancreatic fluid.
We used an endoscopic distal cap attachment to "cap" the ampulla and collect secretin-stimulated pancreatic fluid samples for 5 minutes from 81 patients undergoing pancreatic evaluation as part of the Cancer of the Pancreas Screening studies. We compared mutation concentrations (K-ras and GNAS) measured by droplet-digital PCR (ddPCR) in "cap-collected juice" samples to those found in juice samples obtained from 77 patients collected by aspiration from the duodenal lumen without capping the ampulla.
Among all subjects, mutation concentrations were higher in pancreatic juice samples collected using the endoscopic cap method (median, .028%; IQR, 0-.077) compared with the noncap-collected (median, .019%; IQR, 0-.044; P = .055). Among pancreatic juice samples with detectable mutations, mutation concentrations were higher in the cap-collected juice samples than in those collected without the cap (.055%; IQR, .026-.092 vs .032%; IQR, .020-.066; P = .031).
Collecting pancreatic juice directly from the ampulla using an endoscopic distal cap yields higher concentrations of pancreatic fluid mutations.
十二指肠胰腺液收集物可作为胰腺导管肿瘤发生的突变和其他标志物的来源，但胰液与十二指肠内容物混合会降低突变浓度。从壶腹直接收集胰腺液可能会获得更纯净的胰腺液样本。
我们使用内镜远端帽附件“盖帽”壶腹，并从 81 例接受胰腺癌评估的患者中收集 5 分钟的促胰液素刺激的胰腺液样本，这些患者是癌症胰腺筛查研究的一部分。我们比较了通过液滴数字 PCR（ddPCR）测量的“帽收集的汁液”样本中的突变浓度（K-ras 和 GNAS）与 77 例未盖帽的从十二指肠腔抽吸的胰腺液样本中的突变浓度。
在所有受试者中，使用内镜帽方法收集的胰腺液样本中的突变浓度更高（中位数，0.028%；四分位距，0-0.077%），而未盖帽收集的样本中的突变浓度更低（中位数，0.019%；四分位距，0-0.044%；P=0.055）。在可检测到突变的胰腺液样本中，帽收集的胰腺液样本中的突变浓度高于未盖帽收集的样本（0.055%；四分位距，0.026-0.092 比 0.032%；四分位距，0.020-0.066；P=0.031）。
使用内镜远端帽直接从壶腹收集胰腺液可获得更高浓度的胰腺液突变。
