Endoscopy 2018; 50(04): S194
DOI: 10.1055/s-0038-1637637
ESGE Days 2018 ePosters
Georg Thieme Verlag KG Stuttgart · New York

INTRABILIARY HEPATIC METASTASIS OF COLORECTAL CARCINOMA MIMICKING HEPATOLITHIASIS, SUCCESSFULLY DIAGNOSED USING SINGLE-OPERATOR CHOLANGIOSCOPY – A CASE REPORT

P Karagyozov
1   Acibadem City Clinic Tokuda Hospital, Interventional Gastroenterology, Sofia, Bulgaria
,
I Tishkov
1   Acibadem City Clinic Tokuda Hospital, Interventional Gastroenterology, Sofia, Bulgaria
,
I Boeva
1   Acibadem City Clinic Tokuda Hospital, Interventional Gastroenterology, Sofia, Bulgaria
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

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Aim:

We report a case of intrabiliary hepatic metastasis of CRC that was confirmed by single-operator cholangioscopy.

Methods:

A 68-year-old man was referred to our unit with recurrent attacks of ascending cholangitis in the last 2 months. Patient was operated for rectosigmoid adenocarcinoma staged pT3N0M0G2, 5 years ago. Postoperative adjuvant chemotherapy was conducted. CT, MRI and MRCP showed extra – and intrahepatic bile duct dilation, suspect intrahepatic stones without any other patologic findings. PET/CT showed inflamatory changes in the intrahepatic bile ducts – no suspicion of malignancy. CA19 – 9 and CEA levels were within normal ranges. ERCP was performed showing filling defects in the right hepatic duct. Single- operator cholangioscopy was carried out, using the SpyGlass DS system (Boston Scientific, Marlborough, NA, USA). We found a nodular mass in the distal part of the right hepatic duct, with tortuos vessels, ulcerations, spontaneus bleeding. Cholangioscopy – guided biopsies were taken. 10 French plastic stent was placed transpapillary at the end of the procedure. Histology showed: “metastasisinfiltration from colorectal adenocarcinoma”.

Result:

After discussion on tumor bord patient was refered for surgery.

Conclusion:

Intrabiliary metastasis from colorectal carcinoma growing within or invading bile ducts is not a very common pattern. Multidisciplinary approaches including CT, MRI, PET/CT, ERCP are unsatisfactory in some cases. Accurate diagnosis of metastatic lesions is very important for selection of therapy and prognosis. This case suggests the usefullness of cholangioscopy, particularly when other diagnostic modalities do not provide definitive information.