Copyright
©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Percutaneous transhepatic cholangioscopy-assisted biliary polypectomy for local palliative treatment of intraductal papillary neoplasm of the bile duct
Xu Ren, Yong-Ping Qu, Chun-Lan Zhu, Xiao-Hong Xu, Hong Jiang, Yi-Xia Lu, Hong-Peng Xue
Xu Ren, Digestive Disease Hospital of Heilongjiang Provincial Hospital, Heilongjiang Provincial Clinical Medical Research Center for Minimally Invasive Diagnosis and Treatment of Pancreaticobiliary Diseases, Harbin 150001, Heilongjiang Province, China
Yong-Ping Qu, Digestive Endoscopy Center of Heilongjiang Provincial Hospital, Heilongjiang Provincial Clinical Medical Research Center for Minimally Invasive Diagnosis and Treatment of Pancreaticobiliary Diseases, Harbin 150001, Heilongjiang Province, China
Chun-Lan Zhu, Xiao-Hong Xu, Yi-Xia Lu, Hong-Peng Xue, Second Department of Gastroenterology, Digestive Disease Hospital of Heilongjiang Provincial Hospital, and Heilongjiang Provincial Clinical Medical Research Center for Minimally Invasive Diagnosis and Treatment of Pancreaticobiliary Diseases, Harbin 150001, Heilongjiang Province, China
Hong Jiang, Department of Pathology, Heilongjiang Provincial Hospital, Harbin 150001, Heilongjiang Province, China
Co-first authors: Xu Ren and Yong-Ping Qu.
Author contributions: Ren X and Qu YP contributed equally to this work and share first authorship; Ren X conceived and designed the experiments and prepared the manuscript; Zhu CL, Xu XH, and Xue HP participated in the percutaneous transhepatic cholangioscopy treatment for patients; Qu YP and Lu YX collected and analyzed the data; Jiang H was responsible for pathological diagnosis.
Institutional review board statement: The experimental protocol was established according to the ethical guidelines of the Helsinki Declaration and was approved by Ethics Committee of Heilongjiang Provincial Hospital (Approval No. 2021-104).
Informed consent statement: Written informed consent was obtained from participants.
Conflict-of-interest statement: Authors declare no conflict of Interest for this article.
Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Xu Ren, PhD, Doctor, Digestive Disease Hospital of Heilongjiang Provincial Hospital, Heilongjiang Provincial Clinical Medical Research Center for Minimally Invasive Diagnosis and Treatment of Pancreaticobiliary Diseases, No. 405 Guogeli Street, Harbin 150001, Heilongjiang Province, China. hljxhy2001@126.com
Received: November 29, 2023
Peer-review started: November 29, 2023
First decision: January 15, 2024
Revised: January 29, 2024
Accepted: March 11, 2024
Article in press: March 11, 2024
Published online: May 15, 2024
Processing time: 161 Days and 22.8 Hours
BACKGROUND
Intraductal papillary neoplasm of the bile duct (IPNB) is a premalignant biliary-type epithelial neoplasm with intraductal papillary or villous growth. Currently reported local palliative therapeutic modalities, including endoscopic nasobiliary drainage, stenting and biliary curettage, endoscopic biliary polypectomy, percutaneous biliary drainage, laser ablation, argon plasma coagulation, photodynamic therapy, and radiofrequency ablation to relieve mechanical obstruction are limited with weaknesses and disadvantages. We have applied percutaneous transhepatic cholangioscopy (PTCS)-assisted biliary polypectomy (PTCS-BP) technique for the management of IPNB including mucin-hypersecreting cast-like and polypoid type tumors since 2010.
AIM
To assess the technical feasibility, efficacy, and safety of PTCS-BP for local palliative treatment of IPNB.
METHODS
Patients with mucin-hypersecreting cast-like or polypoid type IPNB and receiving PTCS-BP between September 2010 and December 2019 were included. PTCS-BP was performed by using a half-moon type snare with a soft stainless-steel wire, and the tumor was snared and resected with electrocautery. The primary outcome was its feasibility, indicated by technical success. The secondary outcomes were efficacy, including therapeutic success, curative resection, and clinical success, and safety.
RESULTS
Five patients (four with mucin-hypersecreting cast-like type and one with polypoid type IPNB) were included. Low- and high-grade intraepithelial neoplasia (HGIN) and recurrent IPNB with invasive carcinoma were observed in one, two, and two patients, respectively. Repeated cholangitis and/or obstructive jaundice were presented in all four patients with mucin-hypersecreting cast-like type IPNB. All five patients achieved technical success of PTCS-BP. Four patients (three with mucin-hypersecreting cast-like type and one with polypoid type IPNB) obtained therapeutic success; one with mucin-hypersecreting cast-like type tumors in the intrahepatic small bile duct and HGIN had residual tumors. All four patients with mucin-hypersecreting IPNB achieved clinical success. The patient with polypoid type IPNB achieved curative resection. There were no PTCS-BP-related serious adverse events.
CONCLUSION
PTCS-BP appears to be feasible, efficacious, and safe for local palliative treatment of both mucin-hypersecreting cast-like and polypoid type IPNB.
Core Tip: Technical feasibility, efficacy, and safety of percutaneous transhepatic cholangioscopy-assisted biliary polypectomy (PTCS-BP) for local palliative treatment of intraductal papillary neoplasm of the bile duct (IPNB) were assessed. PTCS-BP was performed in four patients with mucin-hypersecreting cast-like type and one with polypoid type IPNB. All five patients achieved technical success, and four patients achieved therapeutic success. All the four patients with mucin-hypersecreting cast-like type IPNB achieved clinical success, and the patient with polypoid type IPNB achieved curative resection. Therefore, PTCS-BP appears to be feasible, efficacious, and safe for local palliative treatment of both cast-like and polypoid type IPNB.
