Photodynamic therapy of extrahepatic cholangiocarcinoma using digital cholangioscopy

Abstract

Background: Cholangiocarcinoma is an aggressive neoplasm that usually requires palliative biliary drainage. Photodynamic therapy (PDT) has been described as a successful adjunct treatment to malignant biliary obstruction. Aim: To describe the use of digital cholangioscope to help provide laser light during biliary PDT session using locally developed light source. Method: Patient receives intravenous photosensitizer 24 h before the procedure. It starts with a regular duodenoscopy. After identification of the major papilla and retrograde cannulation, the digital cholangioscope is introduced into the common bile duct. Then, the cholangioscopic examination helps to identify the neoplastic stricture. Under direct visualization lighting catheter is advanced through the cholangioscope. Repositioning is recommended every centimeter to cover all strictured area. At the end of the procedure, a final cholangioscopy assesses the bile duct for the immediate result and adverse events. Result: This procedure was applied in one 82-year-old male due to obstructive jaundice in the last two months. EUS and ERCP revealed a severe dilation of the common bile duct associated with choledocholithiasis. Besides, was revealed dilation of hepatic duct up to a well-circumscribed hypoechoic solid mass measuring 1.8x2 cm compressing the common hepatic duct. The mass was deemed unresectable and the patient was referred for palliative treatment with PDT. He remained asymptomatic for three months. He perished due to complications 15 months after the PDT session. Conclusion: Digital cholangioscopy-guided biliary PDT is feasible and seems safe and effective as an adjunct modality in the palliation of extrahepatic cholangiocarcinoma.

Choledochoscopy: An update

“…Novel choledochoscopy-guided balloon-radiofrequency ablation techniques demonstrated in animal models also show potential for clinical use[ 36 ]. Case reports by Chandrasekar et al [ 37 ] and Brunaldi et al [ 38 ] describe the use of digital cholangioscopy to evaluate photodynamic therapy.…”

Intrahepatic Biliary Strictures With Underlying Pre-Malignant Biliary Lesions: Is It Time to Build Guidelines on Diagnosis and Management?

“…Another reported technique in the evaluation of indeterminate biliary lesions is the SpyGlass single-operator peroral cholangioscopy 4 , 9 . Woo et al 19 reported that overall accuracy of SpyGlass visual assessment and SpyBite biopsy for the diagnosis of malignancy were 96.7% and 73.6%, respectively.…”