Post written by Yadong Feng, MD, from the Department of Gastroenterology, Zhongda Hospital Affiliated to Southeast University, School of Medicine, Southeast University, Nanjing, China.

In this study, we reported the experience of the use of digital cholangioscopy for targeted photodynamic therapy (PDT) of a small hilar intraductal papillary neoplasm of the bile duct (IPNB). A 54-year-old man was admitted to our department with recurrent cholangitis. The diagnosis of IPNB was established by the view of cholangioscopy and histopathological examination.

Generally, aggressive resection is recommended as the first choice. As the size of tumor was small without obvious signs of invasion at the preoperative examination, we attempted resection via cholangioscopy-guided PDT. 

During the procedure, a PDT optical fiber was introduced near the lesions. Excitation light at 630-690 nm was delivered for 20 minutes at a dose of 250 J/cm² and was ceased when a pale view of the lesions was present. The operation was successful without intraprocedural complications. Follow-up MRI revealed less cystic dilation of the bile ducts than before the procedure, and follow-up cholangioscopy (after 4 months) showed fibrosis scars, and no lesion residual was present.

Based on follow-up imaging and endoscopy, this intervention demonstrated a novel therapeutic outcome. The results showed that this cholangioscopy-guided therapy is advantageous by achieving precise treatment for IPNB.

Because of the advantages of the novel digital cholangioscopy, multiple intraluminal direct-visualization-guided therapies are possible.

In conclusion, cholangioscopy-guided PDT is beneficial by achieving precise treatment for IPNB.

A, Fish-egg-like endoscopic appearance of the ampulla of Vater. B, Cholangioscopy showing a significant amount of intraductal mucin. C, Cholangioscopy showing multiple small areas of fish-egg-like papillary projections at the orifice of the right intrahepatic bile duct. D, Biopsy using SpyBite forceps under direct visualization.

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