Case report: serial percutaneous cholangioscopy with laser ablation for the management of locally recurrent biliary intraductal papillary mucinous tumor

Successful cholangioscopic electrocoagulation for biliary papillomatosis: Report covering six cases (with video)

BACKGROUND

Biliary papillomatosis is a rare type of papillomatosis. Depending on the location of the disease, radical surgical resection or liver transplants are the treatment of choice. These radical surgical options may be unrealistic in patients who are not surgical candidates or who are unwilling to consider surgery.

AIMS

To evaluate the effectiveness of endoscopic electrocoagulation for the biliary papillomatosis.

METHODS

In this case series, we report six patients with unresectable biliary papillomatosis who underwent cholangioscopic electrocoagulation using needle knife and their clinic follow up information.

RESULTS

After patients received cholangioscopy with electrocoagulation of the residual biliary papilloma, the daily T-tube drainage volume increased to 200-400ml with improvement in the drainage content and significant relief of clinical symptoms, such as jaundice and abdominal pain.

CONCLUSION

This method of using electrocoagulation to directly target and destroy tumor tissue is a safe and effective alternative for those with unresectable disease, and this method has shown to enhance T-tube drainage volume and improve patients' overall clinical symptoms.

Cholangiopancreatoscopy-guided laser dissection and ablation for pancreas and biliary strictures and neoplasia

Background and study aims  Cholangiopancreatoscopy-guided laser dissection or ablation (CPL) is a novel therapeutic modality for refractory benign strictures. Our aim was to describe the safety and efficacy of CPL for pancreaticobiliary disorders. Patients and methods  Patients who underwent CPL using holmium or thulium laser between February 2017 and September 2019 were included. For stricture dissection, gentle strokes of the laser fiber from a distal to proximal approach were applied until luminal patency permitted advancement of the cholangiopancreatoscope. Immediate technical success was defined as ability to traverse the stricture with the cholangiopancreatoscope after CPL. Short-term technical success was defined as > 90 % resolution of the stricture on follow-up pancreatogram. Results  Eleven patients underwent a mean of 3.6 ERCPs (mean total diameter of 14.2 Fr of stenting) prior to CPL. Indications included pancreatic duct stricture (n = 8), pancreaticojejunostomy anastomotic stricture (n = 1), bile duct stricture (n = 1) and pancreatic intraductal papillary mucinous neoplasm ablation (n = 1). Immediate technical success was 94.1 % and short-term technical success rates was 88.2 %. At a mean follow-up of 12.1 months, there have been no stricture recurrences. Conclusions  CPL may be an effective therapy for strictures refractory to conventional dilation and multiple stenting.

Percutaneous Transhepatic Cholangioscopy

The role of the interventional radiologist continues to expand in the treatment of biliary disease. Percutaneous transhepatic cholangioscopy (PTCS) provides direct visualization of the biliary system for diagnostic and therapeutic interventions, especially in cases where anatomical considerations prohibit a peroral approach. Visual inspection and endoscopically guided biopsy allow differentiation between benign and malignant lesions, as well as accurate assessment of the tumor extent for surgical planning. Studies have demonstrated greater than 95% accuracy with PTCS in diagnosing biliary malignancies. Cholangioscopy is also used to treat obstructive stones in the biliary system, which may require laser lithotripsy. PTCS-guided removal of biliary stones is highly successful, with complete stone removal from the bile ducts occurring in approximately 90% of cases. Overall, PTCS is a safe and effective procedure, with severe complications occurring in less than 8% of patients. The purpose of this review is to familiarize its reader with common indications for PTCS, techniques for procedural success, expected outcomes, and management of potential complications.

Endoscopic retrograde cholangiopancreatography complications in the era of cholangioscopy: is there an increased risk?

BACKGROUND

Single-operator cholangioscopy allows direct visualization of the biliary tree and is being used in the diagnosis and treatment of various biliary conditions. To date, there are few data examining complications of single-operator cholangioscopy.

METHODS

We evaluated all endoscopic retrograde cholangiopancreatography procedures over a two-year period and compared its complication rate to single-operator cholangioscopy in a tertiary care centre with extensive experience in single-operator cholangioscopy. A total of 2087 patients (55% men, mean age 57.4±16.4) had a therapeutic endoscopic retrograde cholangiopancreatography, out of which 169 also had single-operator cholangioscopy performed on them.

RESULTS

169 single-operator cholangioscopy procedures were performed (53% men) with a mean patient age of 60.7±15.2 years. Out of the 2087 patients, 160 complications occurred (7.7%), and included pancreatitis (n=47, 2.2%), infection (n=24, 1.1%), bleeding (n=44, 2.1%), perforation (n=16, 0.8%) and other (n=29, 1.4%). Univariate analysis on overall complications identified seven variables with a p value<0.2, which were included in the multivariate analysis. Biliary sphincterotomy, pancreatic duct stent placement, and ampullectomy were associated with increased complications. Single-operator cholangioscopy was not associated with increased complications on multivariate analysis.

CONCLUSION

Single-operator cholangioscopy is not associated with an increased rate of complications when compared to endoscopic retrograde cholangiopancreatography. The types and frequencies of overall endoscopic retrograde cholangiopancreatography complications are similar to previously reported series.

Advances in research on biliary papillomatosis

Biliary papillomatosis is a rare disease that occurs more commonly in elderly males. The usual presentation of this disease is obstructive jaundice or recurrent cholangitis. Characterized by multiple papillary adenomas involving extensive areas of the biliary tree, biliary papillomatosis has a high recurrence rate and a significant risk of malignant transformation. Here, we will review the pathogenesis, clinical features, diagnosis and therapy of biliary papillmatosis.