Related Experiment Video
Updated: Mar 6, 2026
Isolation of Proximal Fluids to Investigate the Tumor Microenvironment of Pancreatic Adenocarcinoma
Published on: November 5, 2020
Using an endoscopic distal cap to collect pancreatic fluid from the ampulla (with video)
Masaya Suenaga1, Yoshihiko Sadakari1, Jose Alejandro Almario1
1Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Background And Aims:
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.
Methods:
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.
Results:
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).
Conclusions:
Collecting pancreatic juice directly from the ampulla using an endoscopic distal cap yields higher concentrations of pancreatic fluid mutations.
Insights
Collecting pancreatic fluid directly from the ampulla using an endoscopic cap method increases the concentration of pancreatic ductal neoplasia mutations compared to traditional duodenal collection methods.
Area of Science:
- Gastroenterology
- Oncology
- Molecular Diagnostics
Background:
- Duodenal pancreatic fluid samples are used to detect mutations for pancreatic ductal neoplasia.
- Admixing pancreatic juice with duodenal contents dilutes mutation concentrations.
- Direct ampullary collection may provide purer pancreatic fluid samples.
Purpose of the Study:
- To evaluate a novel endoscopic distal cap method for collecting pancreatic fluid directly from the ampulla.
- To compare mutation concentrations in cap-collected versus non-cap-collected pancreatic fluid samples.
Main Methods:
- An endoscopic distal cap attachment was used to collect secretin-stimulated pancreatic fluid from the ampulla in 81 patients.
- Mutation concentrations (K-ras, GNAS) were measured using droplet-digital PCR (ddPCR).
- Cap-collected samples were compared to duodenal lumen aspirates from 77 patients.
Main Results:
- Overall mutation concentrations were higher in cap-collected samples (median 0.028%) versus non-cap-collected samples (median 0.019%; P=0.055).
- For samples with detectable mutations, concentrations were significantly higher in cap-collected samples (0.055%) than non-cap-collected samples (0.032%; P=0.031).
Conclusions:
- Direct ampullary collection of pancreatic fluid using an endoscopic distal cap yields higher concentrations of pancreatic fluid mutations.
- This method may improve the detection of pancreatic ductal neoplasia markers.
Related Concept Videos
01:26Endoscopic Procedures V: ERCP
Patient...
01:28Endoscopic Procedures III: Video Capsule Endoscopy