THE IMPORTANCE OF CHOLANGIOSCOPY IN THE DIAGNOSIS OF INTRADUCTAL LESIONS OF THE BILIARY TRACT

Aims Illustrate the importance of ERCP and cholangioscopy.

Methods Retrospective review of the clinical process.

Results Male of 41-years-old with postprandial infarction, nausea and weight loss (5 kg, 7% total weight) with two years evolution. On examination, he presented scleral icterus. Analytically, conjugated hyperbilirubinemia (BT 3.62mg/dL/Bd 2.60mg/dL) and cytocholestasis (AST 102U/L, ALT 144U/L, FA 330U/L, GGT 681U/L) stood out.

Abdominal CT showed intra and extrahepatic biliary tract dilatation, and MRCP described dilatation of the intrahepatic bile duct and main biliary duct (MBD) with a reduction in the caliber of the distal half, without parietal changes or endoluminal images.

He underwent ERCP showing a heterogeneous filling defect in the distal half of the MBD, with upstream dilatation. Biliary sphincterotomy and exploration with a balloon and Dormia basket were performed, with the removal of fragments of tumor tissue, villous in appearance, with hemorrhagic and necrotic areas. Cholangioscopy identified a villous and friable exophytic lesion in the middle third of the MBD, which caused insurmountable stenosis. Biopsies revealed an intraductal tubulopapillary neoplasm with high-grade dysplasia, with focal transformation into adenocarcinoma (ADC).

Imaging staging was completed, without evidence of metastasis. A Whipple's cephalic pancreaticoduodenectomy with hepatico-jejunostomy was performed. The anatomopathological examination of the surgical specimen showed moderately differentiated ADC from the biliary tract, in an intraductal papillary neoplasm of the biliary tract (IPNB), (pT1N0R0).

Conclusions IPNB are percussive lesions of cholangiocarcinoma, which don’t have a typical clinical or imaging presentation. Early diagnosis is a clinical challenge, and ERCP and cholangioscopy are fundamental for characterization of these lesions.

Publication History

Article published online:
14 April 2022