A Study of Malignant Bile Duct Stenosis Using Percutaneous Transhepatic Cholangioscopy

Abstract

From June, 1987 to November, 1989, 11 patients with malignant bile duct stenosis, which was later confirmed by surgery or autopsy, were examined by percutaneous transhepatic cholangioscopy (PTCS) and by an endoscopic biopsy. The endoscopic findings obtained with the usual observation methods and methylene blue staining and the histological findings of the biopsy specimens were compared. A fine vascular proliferation was seen in all of the patients and a granular appearance was noted in patients with carcinoma of the major papilla. The papillary appearance was noted in one case each of pancreatic carcinoma, bile duct carcinoma and carcinoma of the major papilla. Marginal protrusion was not noted in patients with pancreatic carcinoma. A distorted narrow segment was seen only in cases of pancreatic carcinoma. The presence of a granular appearance indicated that the carcinoma was exposed on the surface. A high degree of fine vascular proliferation and a papillary appearance tended to indicate a carcinoma which invaded mainly into the fibromuscular layer without invasion of the mucosa. The methylene blue staining method was simple and effective for better visualization of the surface structure of the abnormal area, normal mucosa and the border zone.

Relationship Between Percutaneous Transhepatic Cholangioscopy Findings and Pattern of Carcinomatous Spread in the Bile Duct

“…Since then, PTCS has been widely used for diagnosing the intracholedochal spread of carcinoma and the histological diagnosis of malignancies of the pancreatobiliary system. Many authors reported a relationship between PTCS findings and the rates of carcinoma positivity on biopsies (Yamase et al, 1988, Nishikawa et al, 1991, Sato Met al, 1992 as well as characteristic PTCS findings ofcarcinoma ofthe choledochus, pancreas, and ampullary region (Yamase et al, 1988, Nishikawa et al, 1991. However, few investigators investigated the relationship between PTCS findings and the pattern of carcinomatous spread in detail.…”

“…Vascular dilation is synonymous with tumor vessel (Kamiya et al, 1988, Yamase et al, 1988, capillary sign (Nakazawa et al, 1985) and fine vascular proliferation (Nishikawa et al, 1991), all reported previously. Nimura et al (Nimura et al, 1988) reported finding tumor vessels in all cases of bile duct carcinoma and carcinoma of the papillary region, and in 68% of the pancreatic carcinoma.…”

Peroral Cholangioscopy Using a New Thinner Videoscope (Chf‐b260)

“…POCS allows direct imaging of bile duct lesions, and thus is effective for diagnosing both benign and malignant conditions. It is important to observe the surface and the vascular pattern of the bile duct mucosa to make a diagnosis of malignancy 2,3 . There are several methods by which a fiberscope can be inserted directly into the bile duct.…”

ROLE OF PERORAL CHOLANGIOSCOPY IN THE PREOPERATIVE DIAGNOSIS OF MALIGNANT MIDDLE and LOWER BILE DUCT CANCERS: A PRELIMINARY STUDY USING 10 FR PLASTIC STENT

“…Furthermore, in operable cases, it may be a major disadvantage that we cannot observe the proximal site of stricture, making it difficult to take a biopsy. Therefore, PTCS is needed by precise diagnosis to determine the incision line 3,4 . In general, to perform PTCS, at least 2 weeks are needed for completion of fistula.…”

“…However, although the baby scope with working channel for biopsy has large diameter, it is difficult for expert endoscopists to pass the biliary stricture. Therefore, percutaneous transhepatic cholangioscopes (PTCS) have been often performed to determine of the incision line 3,4 . In this study, we introduced useful methods for preoperative diagnosis of the middle or lower biliary tract cancers by direct view using POCS in combination with biopsy forceps.…”