Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Shinkawa 6-20-2, Mitaka-shi, Tokyo, 181-8611, Japan.
Department of Radiology, Kyorin University School of Medicine, Shinkawa 6-20-2, Mitaka-shi, Tokyo, 181-8611, Japan.
BMC Gastroenterol. 2020 May 24;20(1):158. doi: 10.1186/s12876-020-01304-0.
Endoscopic retrograde cholangiopancreatography (ERCP) is still performed using two-dimensional (2D) X-ray images. The success rate and risk of complications are considered operator-dependent. We explored performing an ERCP-related procedure with 3D-computed tomography (CT) biliary imaging for preoperative simulation and intraoperative reference in a patient with malignant biliary obstruction.
The patient was a 66-year-old man who underwent rectal resection and postoperative chemotherapy for rectal cancer. A liver metastasis caused obstructive jaundice and acute cholangitis, necessitating emergency hospitalization. A 3.5 cm mass in the hilar region of the biliary tree caused type IV biliary obstruction according to the Bismuth-Corlette classification of hilar cholangiocarcinoma. ERCP and biliary drainage were performed repeatedly, but had no effect. Given that selective bile duct drainage had proven extremely difficult with the conventional procedures, three-dimensional (3D) images were created from preoperative CT image data using a 3D image reconstruction system (SYNAPSE VINCENT version 5, FUJIFILM Corporation, Tokyo, Japan). Using the 3D images for preoperative planning and intraoperative reference, biliary drainage and stent placement were successfully performed without complications. Postoperatively, the patient had no further cholangitis or need for stent replacement up to his death.
We report the first case of an ERCP-related procedure with 3D biliary imaging for preoperative simulation and intraoperative reference in a patient with malignant biliary obstruction. The 3D image reconstruction is useful for preoperative planning and could contribute to an increased success rate, decreased complications, a shorter operation time, and reduced radiation exposure to the operator.
内镜逆行胰胆管造影术（ERCP）仍采用二维（2D）X 射线图像进行。成功率和并发症风险被认为与操作者有关。我们探索在一名恶性胆道梗阻患者中使用 3D 计算机断层扫描（CT）胆道成像进行术前模拟和术中参考，以进行 ERCP 相关操作。
患者为 66 岁男性，因直肠癌行直肠切除术和术后化疗。肝转移导致梗阻性黄疸和急性胆管炎，需要紧急住院治疗。肝门胆管树的 3.5cm 肿块根据肝门部胆管癌的 Bismuth-Corlette 分类导致 IV 型胆道梗阻。反复进行 ERCP 和胆道引流，但无效果。由于常规操作已证明选择性胆管引流极其困难，因此使用 3D 图像重建系统（SYNAPSE VINCENT 版本 5，FUJIFILM Corporation，东京，日本）从术前 CT 图像数据创建三维（3D）图像。使用 3D 图像进行术前规划和术中参考，成功进行了胆道引流和支架置入，无并发症发生。术后，患者未再发生胆管炎，也无需更换支架，直至死亡。
我们报告了首例恶性胆道梗阻患者使用 3D 胆道成像进行术前模拟和术中参考的 ERCP 相关操作。3D 图像重建有助于术前规划，并可能提高成功率、降低并发症发生率、缩短手术时间和减少操作人员的辐射暴露。
