Ren Xu, Qu Yong-Ping, Zhu Chun-Lan, Xu Xiao-Hong, Jiang Hong, Lu Yi-Xia, Xue Hong-Peng
Digestive Disease Hospital of Heilongjiang Provincial Hospital, Heilongjiang Provincial Clinical Medical Research Center for Minimally Invasive Diagnosis and Treatment of Pancreaticobiliary Diseases, Harbin 150001, Heilongjiang Province, China.
Digestive Endoscopy Center of Heilongjiang Provincial Hospital, Heilongjiang Provincial Clinical Medical Research Center for Minimally Invasive Diagnosis and Treatment of Pancreaticobiliary Diseases, Harbin 150001, Heilongjiang Province, China.
World J Gastrointest Oncol. 2024 May 15;16(5):1821-1832. doi: 10.4251/wjgo.v16.i5.1821.
Intraductal papillary neoplasm of the bile duct (IPNB) is a premalignant biliary-type epithelial neoplasm with intraductal papillary or villous growth. Currently reported local palliative therapeutic modalities, including endoscopic nasobiliary drainage, stenting and biliary curettage, endoscopic biliary polypectomy, percutaneous biliary drainage, laser ablation, argon plasma coagulation, photodynamic therapy, and radiofrequency ablation to relieve mechanical obstruction are limited with weaknesses and disadvantages. We have applied percutaneous transhepatic cholangioscopy (PTCS)-assisted biliary polypectomy (PTCS-BP) technique for the management of IPNB including mucin-hypersecreting cast-like and polypoid type tumors since 2010.
To assess the technical feasibility, efficacy, and safety of PTCS-BP for local palliative treatment of IPNB.
Patients with mucin-hypersecreting cast-like or polypoid type IPNB and receiving PTCS-BP between September 2010 and December 2019 were included. PTCS-BP was performed by using a half-moon type snare with a soft stainless-steel wire, and the tumor was snared and resected with electrocautery. The primary outcome was its feasibility, indicated by technical success. The secondary outcomes were efficacy, including therapeutic success, curative resection, and clinical success, and safety.
Five patients (four with mucin-hypersecreting cast-like type and one with polypoid type IPNB) were included. Low- and high-grade intraepithelial neoplasia (HGIN) and recurrent IPNB with invasive carcinoma were observed in one, two, and two patients, respectively. Repeated cholangitis and/or obstructive jaundice were presented in all four patients with mucin-hypersecreting cast-like type IPNB. All five patients achieved technical success of PTCS-BP. Four patients (three with mucin-hypersecreting cast-like type and one with polypoid type IPNB) obtained therapeutic success; one with mucin-hypersecreting cast-like type tumors in the intrahepatic small bile duct and HGIN had residual tumors. All four patients with mucin-hypersecreting IPNB achieved clinical success. The patient with polypoid type IPNB achieved curative resection. There were no PTCS-BP-related serious adverse events.
PTCS-BP appears to be feasible, efficacious, and safe for local palliative treatment of both mucin-hypersecreting cast-like and polypoid type IPNB.
胆管内乳头状肿瘤（IPNB）是一种具有导管内乳头状或绒毛状生长的癌前胆管型上皮肿瘤。目前报道的局部姑息性治疗方式，包括内镜鼻胆管引流、支架置入和胆管刮除术、内镜下胆管息肉切除术、经皮胆管引流、激光消融、氩等离子体凝固、光动力疗法以及射频消融以缓解机械性梗阻等，都存在局限性和缺点。自2010年以来，我们应用经皮肝穿刺胆管镜检查（PTCS）辅助胆管息肉切除术（PTCS - BP）技术来治疗IPNB，包括黏液高分泌铸型和息肉样类型的肿瘤。
评估PTCS - BP对IPNB进行局部姑息治疗的技术可行性、疗效及安全性。
纳入2010年9月至2019年12月期间接受PTCS - BP治疗的黏液高分泌铸型或息肉样类型IPNB患者。PTCS - BP采用带有软不锈钢丝的半月形圈套器进行，用圈套器套住肿瘤并用电灼切除。主要结局是其可行性，以技术成功来表示。次要结局是疗效，包括治疗成功、根治性切除和临床成功，以及安全性。
共纳入5例患者（4例黏液高分泌铸型类型和1例息肉样类型IPNB）。分别在1例、2例和2例患者中观察到低级别和高级别上皮内瘤变（HGIN）以及伴有浸润性癌的复发性IPNB。所有4例黏液高分泌铸型类型IPNB患者均出现反复胆管炎和/或梗阻性黄疸。所有5例患者均取得PTCS - BP的技术成功。4例患者（3例黏液高分泌铸型类型和1例息肉样类型IPNB）获得治疗成功；1例肝内小胆管黏液高分泌铸型类型肿瘤且为HGIN的患者有残留肿瘤。所有4例黏液高分泌IPNB患者均取得临床成功。息肉样类型IPNB患者实现了根治性切除。未发生与PTCS - BP相关的严重不良事件。
PTCS - BP对于黏液高分泌铸型和息肉样类型IPNB的局部姑息治疗似乎是可行、有效且安全的。
