Endoscopic Endoluminal Radiofrequency Ablation and Single-Operator Peroral Cholangioscopy System (SpyGlass) in the Diagnosis and Treatment of Intraductal Papillary Neoplasm of the Bile Duct: A Case Report and Literature Review
Abstract:Background: Intraductal papillary neoplasm of the bile duct (IPNB) is a rare biliary benign tumor with atypical clinical features and is frequently misdiagnosed. Its treatment is limited and surgical resection is thought to be the only therapeutic option in patients with IPNB. With the aim of increasing the early diagnosis rate of IPNB and providing more therapeutic options for surgeons, we innovatively put forward the concept of combined utilization of SpyGlass and endoscopic endoluminal radiofrequency ablati… Show more
“…In a previous study, spyglass and endoscopic endoluminal radiofrequency ablation were combined to increase early diagnosis rates and provide more therapeutic options. This combination was found to be effective in selected patients [ 19 ]. Despite all the research that has been done till date, the etiology of IPNB is still unclear.…”
Background
Intraductal papillary neoplasm of the bile duct (IPNB) is a premalignant neoplasm that can involve both the intrahepatic and extrahepatic bile ducts. Owing to the low incidence and confusing nomenclature, its clinicopathological features remain controversial. Additionally, only a few studies have reported on the long-term prognosis of IPNB to date. Therefore, the present study aimed to clarify the clinicopathological characteristics and prognosis of IPNB.
Methods
Medical records of patients with IPNB treated at our hospital between August 2000 and October 2021 were retrospectively reviewed. A database of demographic characteristics, test results, surgical details, pathological findings, and follow-up information was constructed for analysis. Patients were divided into intrahepatic and extrahepatic groups, and dysplasia and invasive carcinoma groups for comparison. Differences between study groups were analyzed using the χ2 test, Fisher’s exact test, t-test, or Mann–Whitney U test, as appropriate. Cumulative survival rates were estimated using the Kaplan–Meier method.
Results
In total, 43 patients (21 men and 22 women) with IPNB were included in the study. The median age at diagnosis was 62 (54–69) years. Thirty-eight patients underwent surgery. The mean operation time was (269.5 ± 94.9) min. Five patients underwent endoscopic retrograde cholangiopancreatography for biopsy. Twenty-one and 22 patients had intrahepatic and extrahepatic lesions, respectively. The extrahepatic group had more patients with intraluminal masses (p = 0.021) and abnormal bilirubin levels (p = 0.001), but fewer patients with hepatolithiasis (p = 0.021). The operation time was longer in patients with extrahepatic lesions (p = 0.002). Twenty patients had dysplasia and 23 had invasive carcinoma. The invasive carcinoma group had a longer operation time than the dysplasia group (p = 0.004). As of March 2022, 39 patients were followed up, with a mean follow-up time of (56.2 ± 38.2) months. Fifteen patients survived without tumors, two survived with tumors, and 22 patients died. The 1-, 3-, 5-, and 10-year cumulative overall survival rates were 86.9%, 65.8%, 49.8%, and 32.0%, respectively.
Conclusions
IPNB is a rare bile duct disease that occurs mainly in patients with advanced age. Surgery is the primary treatment strategy. Intrahepatic and extrahepatic lesions, as well as dysplasia and invasive carcinoma have their own unique characteristics. The long-term prognosis of IPNB is generally poor.
“…In a previous study, spyglass and endoscopic endoluminal radiofrequency ablation were combined to increase early diagnosis rates and provide more therapeutic options. This combination was found to be effective in selected patients [ 19 ]. Despite all the research that has been done till date, the etiology of IPNB is still unclear.…”
Background
Intraductal papillary neoplasm of the bile duct (IPNB) is a premalignant neoplasm that can involve both the intrahepatic and extrahepatic bile ducts. Owing to the low incidence and confusing nomenclature, its clinicopathological features remain controversial. Additionally, only a few studies have reported on the long-term prognosis of IPNB to date. Therefore, the present study aimed to clarify the clinicopathological characteristics and prognosis of IPNB.
Methods
Medical records of patients with IPNB treated at our hospital between August 2000 and October 2021 were retrospectively reviewed. A database of demographic characteristics, test results, surgical details, pathological findings, and follow-up information was constructed for analysis. Patients were divided into intrahepatic and extrahepatic groups, and dysplasia and invasive carcinoma groups for comparison. Differences between study groups were analyzed using the χ2 test, Fisher’s exact test, t-test, or Mann–Whitney U test, as appropriate. Cumulative survival rates were estimated using the Kaplan–Meier method.
Results
In total, 43 patients (21 men and 22 women) with IPNB were included in the study. The median age at diagnosis was 62 (54–69) years. Thirty-eight patients underwent surgery. The mean operation time was (269.5 ± 94.9) min. Five patients underwent endoscopic retrograde cholangiopancreatography for biopsy. Twenty-one and 22 patients had intrahepatic and extrahepatic lesions, respectively. The extrahepatic group had more patients with intraluminal masses (p = 0.021) and abnormal bilirubin levels (p = 0.001), but fewer patients with hepatolithiasis (p = 0.021). The operation time was longer in patients with extrahepatic lesions (p = 0.002). Twenty patients had dysplasia and 23 had invasive carcinoma. The invasive carcinoma group had a longer operation time than the dysplasia group (p = 0.004). As of March 2022, 39 patients were followed up, with a mean follow-up time of (56.2 ± 38.2) months. Fifteen patients survived without tumors, two survived with tumors, and 22 patients died. The 1-, 3-, 5-, and 10-year cumulative overall survival rates were 86.9%, 65.8%, 49.8%, and 32.0%, respectively.
Conclusions
IPNB is a rare bile duct disease that occurs mainly in patients with advanced age. Surgery is the primary treatment strategy. Intrahepatic and extrahepatic lesions, as well as dysplasia and invasive carcinoma have their own unique characteristics. The long-term prognosis of IPNB is generally poor.
“…If endoscopic treatment is not applicable, percutaneous intervention should be performed. During the endoscopic intervention, attention should be paid to evaluating the progression of biliary lesions, cholangiography, IDUS, and peroral cholangioscopy, etc, are recommended for detailed assessment 71,72 . After RFA treatment for ampullary cancer, regular duodenoscopy and EUS should be performed, along with deep biopsy and biliary brushing, to determine whether there is tumor residue or recurrence, which can serve as evidence for repeat RFA treatment. Recommendation 13: Long‐term follow‐up is recommended after RFA treatment, usually at an interval of every 3 months.…”
Section: Follow‐up and Efficacy Evaluationmentioning
Endoscopic guided endobiliary radiofrequency ablation has recently been an emerging treatment for malignant biliary strictures. It can effectively delay the local progression of tumors, improve the quality of life, and prolong the survival of patients, combined with biliary stenting and systemic chemotherapy, etc, which is mainly suitable for inoperable patients with extrahepatic cholangiocarcinoma and ampullary cancer. Based on the existing clinical evidence, the Chinese Society of Digestive Endoscopy, the Digestive Endoscopy Professional Committee of the Chinese Medical Doctor Association, and the National Clinical Research Center for Digestive Diseases (Shanghai) organized relevant experts to discuss the indications, contraindications, technical operation specifications and complications prevention and treatment of endoscopically guided endobiliary radiofrequency ablation. They reached consensus statements to provide references for the clinical standardized treatment of biliary malignant tumors.This article is protected by copyright. All rights reserved.
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