Aims Accurate assessment of the lymph node (LN) status is crucial in resectable perihilar cholangiocarcinoma (pCCA) to prevent major surgery in patients with LN metastases. This study investigates the added value of preoperative Endoscopic Ultrasound (EUS) with or without Tissue Acquisition (TA) compared to imaging for the detection of positive LNs in patients with resectable pCCA.

Background: Necrotizing pancreatitis may result in disrupted or disconnected pancreatic duct syndrome, which can lead to several complications. Diagnosis of disconnected pancreatic duct syndrome is not standardized in clinical practice and international guidelines. We therefore performed a systematic review of the current literature on imaging modalities for diagnosing disrupted or disconnected pancreatic duct syndrome in patients with acute pancreatitis. Methods: A systematic search was performed in MEDLINE, Embase and Cochrane library databases up to October 2018 to identify all studies evaluating diagnostic modalities for the diagnoses of disconnected pancreatic duct syndrome in acute pancreatitis. All data regarding diagnostic accuracy were extracted. Results: We included twelve studies, evaluating 286 relevant patients, reporting on five different diagnostic modalities. One study evaluated endoscopic retrograde cholangiopancreatography (ERCP) compared with surgical confirmed disruption, showing a sensitivity of 100%. This was equal to the sensitivity found, in a selective study population, for endoscopic ultrasound (EUS) in detecting a disrupted pancreatic duct. The sensitivity of (secretin)-magnetic resonance cholangiopancreatography (MRCP), as compared with several other diagnostic modalities, ranged from 83.3%-100% and a specificity of 100%. With a sensitivity of 83.3% and specificity of 100% for secretin-MRCP alone. The overall diagnostic accuracy of amylase-measurement in drain fluids for detecting a disrupted pancreatic duct was 65%, with a sensitivity of 100% and a specificity of 50%. The sensitivity for computed tomography was 68%. Conclusion: This systematic review suggests that EUS, ERCP and (secretin)-MRCP are all accurate in diagnosing a disruption or disconnection of the pancreatic duct in patients with acute pancreatitis. Given the poor overall visualization of the pancreatic duct on EUS and the invasive nature of ERCP, however, (secretine)-MRCP is recommended as first diagnostic modality. Further prospective studies are needed to define the optimal timing and diagnostic value of (secretin)-MRCP in different subgroups of patients with necrotizing pancreatitis.