Electrocoagulation of biliary papillomatosis during choledochoscopy

A 39-year-old woman was admitted to our hospital with pain in the right upper quadrant for more than 2 months. Magnetic resource imaging (MRI) showed that the patient had liver calcification, dilatation of the intrahepatic bile duct and upper part of the extrahepatic bile duct, and hepatic parenchymal nodules ([Fig. 1]). The patient had undergone cholecystectomy for gallstones a year previously. For further diagnosis and treatment, we decided to perform biliary exploration.

Fig. 1 Magnetic resonance image showing dilatation of the bile ducts and hepatic parenchymal nodules.

During the procedure, there were no obvious stones seen but many papillary neoplasms with silt-like mucus were seen in the hilar and intrahepatic bile ducts on choledochoscopy ([Fig. 2]), which were thought to be biliary papillomatosis [1]. A biopsy was taken, which confirmed the diagnosis ([Fig. 3]). Biliary papillomatosis is a rare and fatal disease characterized by multiple papillary tumors of variable distribution and extent in the intrahepatic and/or extrahepatic biliary tree [2] [3]. In an effort to destroy the tumors, 6 weeks later, we performed cholangioscopic electrocoagulation through a T-tube tract ([Video 1]). With there being little bleeding during the endoscopic operation, we re-inserted a T-tube into the common bile duct, and the patient returned to the ward safely.

Fig. 2 Choledochoscopy view showing papillary neoplasms in the intrahepatic bile duct.

Fig. 3 Histology of the biopsy specimen showing biliary papillomatosis.

Video 1 Choledochoscopy showing many papillary neoplasms in the hilar and intrahepatic bile ducts. Cholangioscopic electrocoagulation is performed in an effort to destroy the tumors. Follow-up choledochoscopy shows the procedure was a success.

Planned follow-up of the patient by choledochoscopy 3 weeks later showed that the visible bile duct silt-like mucus had disappeared, the hilar and intrahepatic bile ducts were smooth with some scarring visible, but there was no evidence of bile duct papilloma ([Fig. 4]). The patient was discharged from the hospital after a period of time.

Fig. 4 Choledochoscopy view showing that the hilar and intrahepatic bile ducts were smooth although with some scarring.

Endoscopy_UCTN_Code_TTT_1AR_2AF

Competing interests

None

Acknowledgments

The authors wish to thank the Young Scholar’s Scientific Research Fund of Sichuan University, China (2017SCU11057) for their support.

^* Joint first authors

• References

• 1 Lam CM, Yuen ST, Yuen WK. et al. Biliary papillomatosis. Br J Surg 1996; 83: 1715-1716
• 2 Lee SS, Kim MH, Lee SK. et al. Clinicopathologic review of 58 patients with biliary papillomatosis. Cancer 2010; 100: 783-793
• 3 Gunven P, Gorsetman J, Ohlsen H. et al. Six-year recurrence free survival after intraluminal iridium-192 therapy of human bilobar biliary papillomatosis – A case report. Cancer 2000; 89: 69-73