Single-operator cholangioscopy for diagnosis of cholangioadenoma (bile duct adenoma) and its potential impact on surgical management

Abstract

Background and study aims Cholangioadenoma is not recognized commonly and is often only diagnosed on surgical specimens. Direct per oral single-operator cholangioscopy (SOC) allows characterization of common bile duct (CBD) lesions through direct visualization and directed forceps biopsies with potential for impacting surgical management decisions. This is a retrospective review of all SOC cases diagnosed with cholangioadenoma. Patient demographics and outcomes were recorded. Three patients (all male), average age 68 years (range 62 – 76 years), were identified to have a cholangioadenoma. The clinical indication for SOC was deranged liver enzymes with a dilated CBD and a CBD abnormality identified on biliary imaging. The site of cholangioadenoma was proximal, mid and distal CBD, respectively. All patients had a successful SOC with targeted biopsy-proven diagnosis. One patient had a synchronous cholangiocarcinoma and underwent palliative stenting whereas the other two patients underwent appropriate curative resection based on cholangioadenoma location. We conclude that SOC is safe and effective for diagnosis of cholangioadenoma and has potential impact on decisions for surgical management.

Imaging features of intrahepatic bile duct adenoma in MRI

“…(II) Intrahepatic cholangiocarcinoma: uneven signal, often accompanied by shrinkage of the adjacent liver capsule, atrophy of the hepatic lobes at the distal end of the lesion, and dilatation of the intrahepatic bile duct. The dynamic enhancement manifested as mild and moderate peripheral enhancement in the early stage, and progressive and concentric strengthening in the later stage ( 17 , 18 ). (III) Metastatic tumors: having a history of malignant tumors in other parts, generally multiple, varying in size, enhanced with ring-shaped enhancement, and partially with “bull’s eye sign” ( 3 ).…”

Hepatic Duct Adenoma Identified Using Direct Cholangioscopy

“…Recently, direct cholangioscopy has emerged as a valuable tool offering both diagnostic and therapeutic benefits that can guide surgical management [ 5 ]. Eccles et al reported a case series demonstrating the utility of cholangioscopy, where synchronous CBD cholangiocarcinoma and hilar cholangioadenoma were identified, altering surgical management based on findings not visualized in prior imaging studies [ 6 ]. A literature review by Loh et al identified 39 cases of BDAs, with the majority diagnosed via surgical specimens, and only a limited number of cases diagnosed based on biopsies obtained through direct cholangioscopy [ 7 ].…”

Peroral-cholangioscopy to plan surgery for protruding biliary lesions: report of four cases

“…2 Only few series evaluated the role of POCS to diagnose protruding biliary lesions. 3,4 Since its introduction in 1970, cholangioscopy gained progressive attention. 5 While the mother-baby system was heavily burdened by the fragility of the scope, the poor quality of the images and the inconvenience of requiring two operators, the novel peroral cholangioscope (SpyGlass DS, Boston Scientific, USA) is currently a feasible single-operator instrument for high-resolution visualization of the biliary tree.…”