Chiang Cheng-Han, Chen Kuan-Chih, Devereaux Benedict, Chung Chen-Shuan, Kuo Kuei-Chang, Lin Chien Chu, Lin Cheng-Kuan, Wang Hsiu-Po, Chen Kuo-Hsin
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Xin-Tai General Hospital, New Taipei 242063, Taiwan.
Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei 22060, Taiwan.
World J Gastrointest Surg. 2023 May 27;15(5):965-971. doi: 10.4240/wjgs.v15.i5.965.
Cholangiocarcinoma (CC) is a very aggressive cancer with a poor prognosis. As surgery is the only curative therapy, preoperative evaluation of the tumor extent is essential for surgical planning. Although high-quality image modalities such as computed tomography and magnetic resonance imaging have been used extensively in preoperative evaluation, the accuracy is low. To obtain precise localization of tumor spread arising from the hilar region preoperatively, the development of an acceptable imaging modality is still an unmet need.
A 52-year-old female presented to our emergency department with jaundice, abdominal pain, and fever. Initially, she was treated for cholangitis. Endoscopic retrograde cholangiopancreatography with the cholangiogram showed long segment filling defect in the common hepatic duct with dilatation of bilateral intrahepatic ducts. Transpapillary biopsy was performed, and the pathology suggested intraductal papillary neoplasm with high-grade dysplasia. After treatment of cholangitis, contrasted-enhanced computed tomography revealed a hilar lesion with undetermined Bismuth-Corlette classification. SpyGlass cholangioscopy showed that the lesion involved the confluence of the common hepatic duct with one skip lesion in the posterior branch of the right intrahepatic duct, which was not detected by previous image modalities. The surgical plan was modified from extended left hepatectomy to extended right hepatectomy. The final diagnosis was hilar CC, pT2aN0M0. The patient has remained disease-free for more than 3 years.
SpyGlass cholangioscopy may have a role in precision localization of hilar CC to provide surgeons with more information before the operation.
胆管癌（CC）是一种侵袭性很强且预后较差的癌症。由于手术是唯一的治愈性治疗方法，术前评估肿瘤范围对于手术规划至关重要。尽管计算机断层扫描和磁共振成像等高分辨率影像模式已广泛用于术前评估，但其准确性较低。为了在术前获得肝门区肿瘤播散的精确定位，开发一种可接受的成像模式仍是未满足的需求。
一名52岁女性因黄疸、腹痛和发热就诊于我院急诊科。最初，她接受了胆管炎治疗。经内镜逆行胰胆管造影术的胆管造影显示肝总管有长段充盈缺损，双侧肝内胆管扩张。进行了经乳头活检，病理提示导管内乳头状肿瘤伴高级别异型增生。胆管炎治疗后，增强计算机断层扫描显示肝门区病变，Bismuth-Corlette分类不确定。SpyGlass胆管镜检查显示病变累及肝总管汇合处，右肝内胆管后支有一个跳跃性病变，这是之前的影像模式未检测到的。手术方案从扩大左肝切除术改为扩大右肝切除术。最终诊断为肝门部CC，pT2aN0M0。该患者已无病生存超过3年。
SpyGlass胆管镜检查可能在肝门部CC的精确定位中发挥作用，为外科医生在手术前提供更多信息。
