Why is this research question important?
Many patients with pancreatic cancer develop jaundice due to a blockage in the tube draining the liver (bile duct) which needs to be treated before chemotherapy can start. The recommended procedure for this is an Endoscopic Retrograde CholangioPancreatography (ERCP) which is associated with serious complications that delay treatment, including pancreatitis (inflammation of pancreas), and the biopsy is correct in only 40% of patients.
Mr Andrew Smith, a consultant surgeon from Leeds Teaching Hospital NHS Trust is applying for funding for their study which compares other techniques against ERCP. They believe that these alternate techniques have better diagnostic accuracy with less serious complications which allows patients to start treatment faster.
What are you going to do?
During ERCP a flexible camera is passed through the mouth into the small bowel, placing a stent (metal tube) into the bile duct allowing bile to drain, at the same time a biopsy is taken. Recently some UK teams have placed an ERCP stent but used a Endoscopic Ultrasound (EUS) camera to take a biopsy (EUS+ERCP). This biopsy technique is more accurate, diagnosing up to 90% of pancreatic cancers. Early evidence suggests this reduces time to first treatment.
The EUS camera can also be used to place a stent in a procedure called Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) to treat jaundice, avoiding the risk of pancreatitis. This single EUS technique may reduce time to diagnosis, be better tolerated by patients, and be more efficient for the NHS. Andrew is working with 14 UK hospitals to evaluate ERCP against EUS+ERCP or EUS-CDS to find out if patient outcomes can be improved by shortening the diagnostic pathway.
How could the outcomes of this project make a difference to people with pancreatic cancer?
The National Pancreatic Cancer Audit shows significant delays in diagnosis, resulting in an average time to first treatment of 75 days from referral. Diagnostic delays must be reduced to enable more patients to undergo timely treatment and improve outcomes. Optimising PDAC pathways has been highlighted by the James Lind Alliance Priority Setting Partnerships and identified as an unmet clinical need by Pancreatic Cancer UK’s Optimal Care Pathway and the NHSE Faster Diagnostic Standard for pancreatic cancer. The potential impacts of this study are:
- Reducing the pathway length should enable more patients to start chemotherapy, minimising the risk of cancer progression ultimately improving patient survival
- Utilising a more accurate biopsy technique with EUS should reduce the need for repeat procedures, while changing the type of stent used should reduce the severity
of complications - Early effective management would also lead to less repeat procedures, reducing demand on NHS endoscopy and pathology services.
Join the steering committee
The team are looking for an individual with lived experience of pancreatic cancer to help shape and design this study. This individual will be a patient and public involvement (PPI) co-applicant on the application they are submitting. This will make you a member of the trial management team throughout the course of the study which will meet online to discuss various aspects of the project to inform its design.
No scientific background or prior experience is needed to take part in this opportunity.
Next steps
If you would like to join this project or would simply like some further information on this opportunity, please contact Andrew Smith (andrewmsmith@nhs.net) quoting the involvement reference ‘FAST-PANC PPI’.
