Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Surg Proced. Oct 20, 2020; 10(2): 3-8
Published online Oct 20, 2020. doi: 10.5412/wjsp.v10.i2.3
Cholangioscopy-assisted guidewire placement in a malignant biliary stricture: A case report
Grace E Kim, David Yung-An Lo
Grace E Kim, Internal Medicine, University of Maryland Medical Center, Baltimore, MD 21201, United States
David Yung-An Lo, Department of Medicine, The Ohio State University College of Medicine, Ohio Gastroenterology Group, Inc, Columbus, OH 43214, United States
Author contributions: Kim GE performed literature review and drafted the manuscript; Lo DYA performed the case and revised the manuscript.
Informed consent statement: Patient was unable to reach for an informed consent despite multiple attempts.
Conflict-of-interest statement: Dr. Grace Kim and Dr. David Lo do not have any conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Grace E Kim, MD, Staff Physician, Internal Medicine, University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD 21201, United States. grace.kim@som.umaryland.edu
Received: June 18, 2020
Peer-review started: June 18, 2020
First decision: July 25, 2020
Revised: August 23, 2020
Accepted: September 25, 2020
Article in press: September 25, 2020
Published online: October 20, 2020
Processing time: 122 Days and 10.7 Hours
Abstract
BACKGROUND

Cholangioscopy has been described in case reports and series to facilitate guidewire placement in difficult benign biliary strictures. Specifically, it has been infrequently used in difficult benign anastomotic liver transplant biliary strictures to visualize the stricture orifice for guidewire placement. Here we describe a case of guidewire placement through a difficult malignant biliary stricture using single operator cholangioscopy.

CASE SUMMARY

A 74-year-old female presented with jaundice and weight loss. Endoscopic ultrasound and endoscopic retrograde cholangiopancreatography (ERCP) by other endoscopists demonstrated pancreatic adenocarcinoma with a dilated cystic duct (CD) and proximal common bile duct (CBD). The associated distal CBD stricture was dilated and stented with a plastic stent. However she subsequently developed cholangitis, prompting referral for a repeat ERCP. The stent was found to have migrated distally to the confluence of the dilated CD and CBD stricture. Despite using multiple hydrophilic guidewires, the stricture could not be traversed due to preferential wire passage into the dilated CD. SpyGlass DS (Boston Scientific Corp, Marlborough, MA, United States) was then used to visualize the orifices of the CD and CBD stenosis, enabling the guidewire to be placed directly through the stricture into the proximal CBD. A WallFlex covered metal stent (Boston Scientific Corp, Marlborough, MA, United States) was successfully placed, resulting in resolution of her cholangitis.

CONCLUSION

To our knowledge, this is one of the first cases to describe successful cholangioscopic guidewire placement for malignant biliary strictures.

Keywords: Cholangiopancreatoscopy; Malignant biliary stricture; Cholangioscopy; Guidewire placement; Obstructive jaundice; Case report

Core Tip: Cholangioscopy has been described in case reports and series to facilitate guidewire placement in difficult benign biliary strictures, especially in the setting of liver transplants. Most biliary strictures are successfully traversed with standard techniques utilizing hydrophilic guidewires during endoscopic retrograde cholangiopancreatography, but challenges with difficult wire placement can occur when the biliary tree consists of multiple strictures and sharp angulations. Here we describe a case of guidewire placement through a difficult malignant biliary stricture using single operator cholangioscopy, highlighting the versatility of cholangioscopy especially in anatomically challenging patients.