Published online Sep 7, 2013. doi: 10.3748/wjg.v19.i33.5590
Revised: June 28, 2013
Accepted: July 12, 2013
Published online: September 7, 2013
Processing time: 110 Days and 23.1 Hours
When a distal common bile duct neoplasm is at the stage of carcinoma in situ or high-grade dysplasia, it is difficult for the surgeon to decide whether to perform pancreaticoduodenectomy. Here we describe a patient with a progressive dysplastic lesion in the common bile duct, which developed from moderate-high to high-grade dysplasia in approximately 2 mo. The patient refused major surgery. Therefore, endoscopic-assisted photodynamic therapy was performed. The result at follow-up using a trans-T-tube choledochoscope showed that the lesion was completely necrotic. This report is the first to describe the successful treatment of high-grade dysplasia of the distal bile duct using photodynamic therapy via a choledochoscope.
Core tip: Due to significant surgical trauma and a low risk of canceration, surgeons face a dilemma regarding the decision to perform pancreaticoduodenectomy for high-grade dysplasia of the distal bile duct. This report is the first to describe the successful treatment of high-grade dysplasia of the distal bile duct using photodynamic therapy via a choledochoscope. This clinical case demonstrated that photodynamic therapy via a trans-T-tube choledochoscope may be an effective and promising protocol for carcinoma in situ or high-grade dysplasia of the distal common bile duct.