Single-operator cholangioscopy in the diagnosis and treatment planning of hilar intraductal papillary neoplasia of the bile duct: a case report

iGIE Pub Date : 2026-09-01 Epub Date: 2026-03-12 DOI:10.1016/j.igie.2026.03.003

Dario Gambaccini MD, Filippo Ovidi MD, Delio Stefani Donati MD, Veronica Natali MD, Arianna Venturini MD, Gherardo Tapete MD, Valeria Bolognesi MD, Andrea Pancetti MD, Pierfrancesco Visaggi MD, Antonio Grosso MD, Emanuele Marciano MD

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Abstract

A 53-year-old man presented with abdominal pain and cholestasis with normal bilirubin. Computed tomography and magnetic resonance imaging/magnetic resonance cholangiopancreatography suggested a perihilar stricture but could not exclude left-duct extension, and initial multidisciplinary review deemed the case unresectable. Endoscopic retrograde cholangiopancreatography with peroral single-operator cholangioscopy (SOC) obtained biopsy specimens, but the stricture was not traversable; repeat multidisciplinary review pursued antegrade mapping. A left percutaneous transhepatic drain was placed; 11 days after percutaneous drain placement, antegrade percutaneous SOC (pSOC) mapped right duct involvement and confirmed left hepatic duct sparing, revising resectability. The patient underwent associating liver partition and portal vein ligation for staged hepatectomy followed by extended right hepatectomy. Pathology showed intraductal papillary neoplasm of the bile duct with high-grade dysplasia and microscopically negative margins (R0); no adverse events occurred. Combined peroral and pSOC can enable curative surgery when imaging and endoscopic retrograde cholangiopancreatography are inconclusive.

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单刀胆管镜在肝门导管内乳头状瘤变诊断及治疗方案中的应用1例

男，53岁，腹痛，胆汁淤积，胆红素正常。计算机断层扫描和磁共振成像/磁共振胆管造影提示肝门周围狭窄，但不能排除左管延伸，初步多学科审查认为该病例不可切除。经口单操作胆管镜（SOC）内镜逆行胆管造影获得活检标本，但狭窄不可穿越；重复多学科回顾，进行顺行制图。放置左侧经皮肝引流管；经皮置管11天后，顺行经皮SOC （pSOC）显示右肝管受损伤，确认左肝管保留，提高了可切除性。患者行联合肝分区和门静脉结扎术，分阶段肝切除术后行扩大右肝切除术。病理显示胆管内乳头状肿瘤伴高度发育不良，镜下边缘阴性（R0）；无不良事件发生。当影像学和内窥镜逆行胆管造影不确定时，联合经口和pSOC可以使手术治疗成为可能。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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