Post written by Shyam Thakkar, MD, from the Division of Gastroenterology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
An 86-year-old woman was referred for ascending cholangitis, resulting in obstructive jaundice and sepsis. Her initial MR cholangiopancreatography revealed dilated bile ducts without any mass or stone in the ductal system. Endoscopic retrograde cholangiopancreatography revealed soft filling defects in the common bile duct consistent with mucobilia. Despite endoscopic therapy, the patient experienced multiple episodes of recurrent ascending cholangitis due to mucus impaction. Peroral cholangioscopy demonstrated mucobilia, dilated ducts, and nodularities in the cystic duct. Biopsies revealed intraductal papillary neoplasm (IPNB) with low-grade dysplasia. Unfortunately, she was not a surgical candidate due to her multiple medical comorbidities. We elected to perform argon plasma coagulation (APC) therapy of her neoplasm.
We felt it was important to recognize that non-surgical candidates may benefit from minimally invasive endoscopic therapies. This case demonstrates IPNB, a rare disease entity with a high-risk malignant transformation, in which surgical resection is the treatment of choice. However, non-surgical management of biliary neoplasms using APC is a well-tolerated and safe procedure as we describe.
Our intention in presenting this video is for other endoscopists to learn similar, non-invasive, techniques for biliary neoplams when surgical resection is not an option. Additionally, based on the goals of care, complex pathologies such as IPNB can be managed safely and effectively with endoscopic therapy.
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