Endoscopic implantation of iridium wire for treatment of carcinoma of the bile duct.

Primary bile duct carcinoma presents serious challenges in management. These tumors are often not completely resectable. They frequently lead to death by producing obstruction to bile flow and hepatic failure. Initial operations frequently fail because of progression of primary disease. Although bile duct carcinomas respond to radiation, technical constraints limit delivery using an external beam technique. A number of studies have appeared in the literature describing the use of local irradiation delivered by way of catheters placed intraoperatively. In the present study, we have described an alternative method of implantation using a simple endoscopic technique utilizing a choledochojejunocutaneous fistula for access. The advantage of their approach is that the extent of the tumor can be determined visually and biopsy performed, facilitating accurate implant placement. In addition, serial examinations may allow early detection of recurrent disease and fecal retreatment.