CASES OF THE WEEK – “First ever Cholangioscopy (Endoscopy inside the bile duct) at Al Zahra Hospital, Sharjah” by Dr Piyush Somani, Specialist Gastroenterology
A 54 years old female, presented with obstructive jaundice. MRCP was suggestive of long, irregular Common Bile Duct (CBD) stricture. Underwent ERCP with bile duct stent placement. Presented again with obstructive jaundice, patient underwent ERCP, Endoscopic ultrasound (EUS) and Cholangioscopy in one session.
EUS revealed narrowing of the CBD with hypo echoic thickening (3-5 mm) of the wall throughout the whole extent suggestive of possible cholangiocarcinoma. ERCP was performed. The previously placed plastic biliary stent was removed.
Cholangiogram revealed dilated intrahepatic biliary radicals along with long, irregular, narrowing of the CBD (around 5 cm in length) from distal part to the proximal part of the CBD. Mild biliary sphincteroplasty (balloon dilation of papilla) was performed. Over the guide wire inside the CBD, the SPYSCOPE DS-2 (Cholangioscope) was inserted inside the CBD.
Cholangioscopy report:
There was long, irregular narrowing of CBD in the proximal/distal part. Friable, mass (tumour) like lesion with irregular, eccentric thickening of the wall was seen with prominent dilated blood vessels suggestive of cholangiocarcinoma. Using SPYBITE biopsy forceps, two biopsy were taken and the histopathology confirmed cholangiocarcinoma. Metallic biliary stent was placed inside the CBD.
Cholangioscopy is a minimally-invasive endoscopic method used for both direct visual diagnostic evaluation and simultaneous therapeutic intervention of the bile ducts/pancreatic duct.
Indications for Cholangioscopy
- Biopsy of bile duct strictures
- Diagnosing cholangiocarcinoma
- Indeterminate filling defect of bile ducts seen on MRCP/CT or ERCP
- Non-surgical treatment of Mirizzi syndrome (Cystic duct stone)
- Large Bile duct/Pancreatic duct stone extraction and dissolution using electrohydraulic or laser lithotripsy.
In summary, Cholangioscopy is a highly advanced endoscopic technique available only in few hospitals in UAE.
Reference: MEDSCAPE- Cholangioscopy.
