Post written by Masanori Kobayashi, MD, PhD, from the Department of Endoscopy, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.

We present a novel mapping biopsy method using a cytology device as a double-lumen sheath. With this method, it was possible to perform optimal surgery for hilar cholangiocarcinoma in a 65-year-old patient.

Diagnosis of the extension of perihilar cholangiocarcinoma is important in determining the appropriate surgical procedure. However, biopsy from each branch of the bile duct for accurate mapping of tumor extension can involve technical difficulty. In addition, biopsy forceps passing through the biliary stricture caused by the tumor can result in false positive results because of tumor contamination.

In this study, we report a convenient and reliable method of tissue collection upstream of the tumor stenosis using a double-lumen cytology brush device. With this method, the presence of the guidewire, as well as the added stability of the external sheath, allowed for greater technical ease, and the sheath acted as a cover, preventing false positive results. A double-lumen cytology device can be used as a sheath, providing a more convenient and reliable mapping biopsy method for accurate preoperative evaluation of tumor extension than previous methods.

Mapping biopsy of hilar bile duct cancer is a complicated and difficult procedure. Yet, it is an important procedure that requires accuracy. This method allows for simpler and more reliable biopsies and has significant clinical advantages.

We would like to plan a prospective study in high-volume centers for hilar bile duct cancer. Please contact us if you are interested in cooperating in the prospective study.

Images of perihilar cholangiocarcinoma. A, Contrast-enhanced CT showing a 20-mm-long wall thickening in the hilar region (red arrow), suggestive of perihilar cholangiocarcinoma. B, Endoscopic retrograde cholangiography finding of a 20-mm-long stenosis in the hilar region. Red arrows indicate the biopsy sites.

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