Published online May 27, 2023. doi: 10.4240/wjgs.v15.i5.965
Peer-review started: November 25, 2022
First decision: February 15, 2023
Revised: March 7, 2023
Accepted: April 7, 2023
Article in press: April 7, 2023
Published online: May 27, 2023
Cholangiocarcinoma (CC) is a very aggressive cancer with a poor prognosis. As surgery is the only curative therapy, preoperative evaluation of the tumor extent is essential for surgical planning. Although high-quality image modalities such as computed tomography and magnetic resonance imaging have been used extensively in preoperative evaluation, the accuracy is low. To obtain precise localization of tumor spread arising from the hilar region preoperatively, the development of an acceptable imaging modality is still an unmet need.
A 52-year-old female presented to our emergency department with jaundice, abdominal pain, and fever. Initially, she was treated for cholangitis. Endoscopic retrograde cholangiopancreatography with the cholangiogram showed long segment filling defect in the common hepatic duct with dilatation of bilateral intrahepatic ducts. Transpapillary biopsy was performed, and the pathology suggested intraductal papillary neoplasm with high-grade dysplasia. After treatment of cholangitis, contrasted-enhanced computed tomography revealed a hilar lesion with undetermined Bismuth-Corlette classification. SpyGlass cholangioscopy showed that the lesion involved the confluence of the common hepatic duct with one skip lesion in the posterior branch of the right intrahepatic duct, which was not detected by previous image modalities. The surgical plan was modified from extended left hepatectomy to extended right hepatectomy. The final diagnosis was hilar CC, pT2aN0M0. The patient has remained disease-free for more than 3 years.
SpyGlass cholangioscopy may have a role in precision localization of hilar CC to provide surgeons with more information before the operation.
Core Tip: The precise localization of hilar cholangiocarcinoma (CC) is important for surgical planning. This case highlights the important role that SpyGlass cholangioscopy can have in precise localization. However, SpyGlass cholangioscopy may be difficult to perform during the first encounter because of obstruction. A two-step approach for obstructive jaundice caused by hilar CC was proposed: (1) Insertion of biliary plastic stents to relieve jaundice and dilate the stricture site; and (2) Removal of biliary plastic stents after relieving jaundice and subsequent examination of hilar CC involvement by SpyGlass cholangioscopy.