Dias E, Cardoso H, Pereira P, Moutinho-Ribeiro P, Macedo G. Bronchial-biliary fistula secondary to cholangiocarcinoma: long-term efficacy of biliary self-expandable metal stent.
REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS : ORGANO OFICIAL DE LA SOCIEDAD ESPANOLA DE PATOLOGIA DIGESTIVA 2022;
114:758-760. [PMID:
35704365 DOI:
10.17235/reed.2022.8970/2022]
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Abstract
A 77-year-old female with previous medical history of non-cirrhotic chronic hepatitis B and hepatocellular carcinoma treated with sequential partial hepatectomy followed by transarterial chemoembolization complained of pruritus and jaundice. Magnetic resonance cholangiopancreatography revealed a peri-hilar ill-defined stenosing lesion suggestive of malignancy. Endoscopic retrograde cholangiopancreatography with cholangioscopy confirmed a circumferential peri-hilar stenosis with fragile mucosa and tortuous dilated vessels and biopsies of this area were consistent cholangiocarcinoma. After 3 months, she presented with new-onset dyspnea and bilioptysis and abdominal computed tomography revealed a bronchial-biliary fistula. ERCP was performed to place a self-expandable metal stent in the biliary tract, which resulted in rapid clinical improvement. The patient has been followed for 2 years and remains globally stable with two episodes of worsening of bilioptysis secondary to stent obstruction by lithiasis that were easily resolved with Fogarty balloon-assisted extraction, with rapid improvement. This case demonstrates the long-term efficacy of endoscopic biliary drainage with self-expandable metallic stent for bronchial-biliary fistula in the setting of cholangiocarcinoma. .
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