Clinical Endoscopy

Case Report

High-Resolution Probe-Based Confocal Laser Endomicroscopy for Diagnosing Biliary Diseases: Hiroki Koda, Kazuo Hara, Okuno Nozomi, Takamichi Kuwahara, Mizuno Nobumasa, Shin Haba, Miyano Akira, Isomoto Hajime; Clin Endosc 2021;54(6):924-929. Published online March 15, 2021; DOI: https://doi.org/10.5946/ce.2020.191

Probe-based confocal laser endomicroscopy is an endoscopic technique that enables in vivo histological evaluation using fluorescent pigment. The ability to diagnostically differentiate between benign and malignant biliary disease using the “CholangioFlex^TM”, a dedicated biliary device, has been reported. However, the Miami and Paris classifications, used as diagnostic criteria, mainly evaluate findings in the submucosa, and visualizing the epithelium as the main site of lesions remains difficult. To address this problem, we verified the imaging findings and diagnostic ability of three types of probes: CholangioFlex^TM, GastroFlex^TM, and AlveoFlex^TM. With GastroFlex^TM, the clear mucosal epithelium was observed, and differential diagnoses as benign/malignant could be made based on epithelial findings. GastroFlex^TM may be a good first-choice probe for probe-based confocal laser endomicroscopy of biliary diseases, and a new diagnostic classification based on bile duct epithelial findings may provide useful criteria independent of the Miami or Paris classifications.

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Cholangioscopy-based convoluted neuronal network vs. confocal laser endomicroscopy in identification of neoplastic biliary strictures
Carlos Robles-Medranda, Jorge Baquerizo-Burgos, Miguel Puga-Tejada, Domenica Cunto, Maria Egas-Izquierdo, Juan Carlos Mendez, Martha Arevalo-Mora, Juan Alcivar Vasquez, Hannah Lukashok, Daniela Tabacelia
Endoscopy International Open.2024; 12(10): E1118. CrossRef

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Original Article

Inside Plastic Stents versus Metal Stents for Treating Unresectable Malignant Perihilar Biliary Obstructions: A Retrospective Comparative Study: Yoshihide Kanno, Shinsuke Koshita, Takahisa Ogawa, Hiroaki Kusunose, Kaori Masu, Toshitaka Sakai, Keisuke Yonamine, Kazuaki Miyamoto, Toji Murabayashi, Fumisato Kozakai, Jun Horaguchi, Yutaka Noda, Kei Ito; Clin Endosc 2020;53(6):735-742. Published online March 4, 2020; DOI: https://doi.org/10.5946/ce.2020.003

Abstract PDF PubReader ePub

Background
/Aims: The aim of this study was to evaluate outcomes of inside plastic stents (iPSs) versus those of metal stents (MSs) for treating unresectable perihilar malignant obstructions.
Methods
For all patients who underwent endoscopic suprapapillary placement of iPS(s) or MS(s) as the first permanent biliary drainage for unresectable malignant perihilar obstructions between January 2014 and August 2019, clinical outcomes using iPSs (n=20) and MSs (n=85), including clinical efficacy, adverse events, and time to recurrence of biliary obstruction (RBO), were retrospectively evaluated.
Results
There were no differences in clinical effectiveness (95% for the iPS group vs. 92% for the MS group, p=1.00). Procedure-related adverse events, including pancreatitis, acute cholangitis, acute cholecystitis, and death, were observed for 8% of the MS group, although no patient in the iPS group developed such adverse events. The median time to RBO was 561 days (95% confidence interval, 0–1,186 days) for iPSs and 209 days (127–291 days) for MSs, showing a significant difference (p=0.008).
Conclusions
Time to RBO after iPS placement was significantly longer than that after MS placement. IPSs, which are removable, unlike MSs, were an acceptable option.

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DEN Open.2025;[Epub] CrossRef
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Yongxin Ma, Jiaojiao Qi, Xusheng Zhang, Kejun Liu, Yimin Liu, Xuehai Yu, Yang Bu, Bendong Chen
Oncology Letters.2025; 29(5): 1. CrossRef
Endoscopic nasobiliary drainage versus endoscopic biliary stenting for preoperative biliary drainage in patients with malignant hilar biliary obstruction: Propensity score‐matched multicenter comparative study
Hirotoshi Ishiwatari, Takanori Kawabata, Hiroki Kawashima, Yousuke Nakai, Shin Miura, Hironari Kato, Hideyuki Shiomi, Nao Fujimori, Takeshi Ogura, Osamu Inatomi, Kensuke Kubota, Toshio Fujisawa, Mamoru Takenaka, Hiroshi Mori, Kensaku Noguchi, Yuki Fujii,
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Journal of Hepato-Biliary-Pancreatic Sciences.2024; 31(4): 284. CrossRef
A Novel Method of Calculating the Drained Liver Volume Using a 3D Volume Analyzer for Biliary Drainage of Unresectable Malignant Hilar Biliary Obstruction
Naoto Imagawa, Mitsuharu Fukasawa, Shinichi Takano, Satoshi Kawakami, Yoshimitsu Fukasawa, Hiroyuki Hasegawa, Natsuhiko Kuratomi, Shota Harai, Naruki Shimamura, Dai Yoshimura, Shoji Kobayashi, Takashi Yoshida, Mitsuaki Sato, Yuichiro Suzuki, Nobuyuki Enom
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Partial Stent-in-Stent Method with an Uncovered Self-Expandable Metallic Stent for Unresectable Malignant Hilar Bile Duct Obstruction
Takuya Shimosaka, Yohei Takeda, Taro Yamashita, Yuta Seki, Shiho Kawahara, Takayuki Hirai, Noriyuki Suto, Yuri Sakamoto, Wataru Hamamoto, Hiroki Koda, Takumi Onoyama, Kazuya Matsumoto, Kazuo Yashima, Hajime Isomoto, Naoyuki Yamaguchi
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Hirotoshi Ishiwatari, Junya Sato, Hiroki Sakamoto, Takuya Doi, Hiroyuki Ono
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Ahmad Al Nakshabandi, Faisal S. Ali, Iyad Albustami, Hyunsoo Hwang, Wei Qiao, Nicole C. Johnston, Abdullah S. Shaikh, Emmanuel Coronel, Phillip S. Ge, William Ross, Brian Weston, Jeffrey H. Lee
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Saqr Alsakarneh, Mahmoud Y. Madi, Fouad Jaber, Kamal Hassan, Yassine Kilani, Omar Al Ta’ani, Dushyant Singh Dahiya, Amir H. Sohail, Laith Numan, Mohammad Bilal, Wissam Kiwan
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원저 / 담도암 환자에서 담도경적 조직 검사 결과에 영향을 미치는 인자 ( Factors Affecting the Yield of Cholangioscopic Biopsy in the Patients with Bile Duct Cancer ): Korean J Gastrointest Endosc 2001;22(3):146-151. Published online November 30, 2000

Abstract PDF: Background
/Aims: This study analyzed the factors associated with the yield of percutaneous transhepatic cholangioscopic biopsies in patients with bile duct cancer. Methods: One hundred and sixteen patients who had received percutaneous transhepatic cholangioscopy and who had been confirmed as having bile duct cancer were enrolled in this study. Results: When the location of the tumor was divided into intrahepatic (IHD), hilar and common bile duct, the biopsy yield was significantly higher in IHD cancer (93.7%) than in cases of hilar cancer (69.6%) (p<0,05). After a bile duct cancer had been classified as a nodular (n=31), papillary (n=27) or infiltrative type (n=58) upon cholangioscopic findings, the biopsy yields from nodular (96.8%) or papillary types (96,3%) were significantly higher than from infiltrative types (58.6%; p<0.01). However, cholangioscopic classification of bile duct cancer was the only independent factor affecting biopsy yield by multiple logistic regression analysis (p=0,001). The sensitivity of the combination of cholangioscopic biopsy and tumor vessel in overall bile duct cancer, especially in the infiltrative type, was significantly increased when it was compared with that for cholangioscopic biopsies (p<0.01) or for tumor vessels alone (p<0,01). Conclusions: The cholangioscopic classification of bile duct tumors might provide important clues to predict biopsy yield. (Korean J Gastrointest Endosc 2001;22:146 - 151)

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13세 여아에서 발생한 담관낭종 합병의 담도암 1 예 ( A Case of Bile Duct Cancer Arising in Choledochal Cyst in a 13-Year-Old Girl ): Korean J Gastrointest Endosc 2000;21(4):811-814. Published online November 30, 1999

Abstract PDF: Choledochal cyst, also referred to as cystic dilatation of the extrahepatic bile duct, is a rare malformation most frequently seen in female. Malignant changes in choledochal cyst have frequently been described, but only one case of malignant change in childhood has been reported till now. Recently, we experienced a case of bile duct cancer arising in choledochal cyst in a 13-year-old girl. She had been complaining of right upper abdominal pain for 15 days. Abdominal CT scan and ERCP showed a cylindrical dilatation of extrahepatic bile duct with irregular cystic wall mass and multiple liver metastasis which was confirmed as adenocarcinoma by ultrasono-guided needle biopsy. Anomalous pancreaticobiliary ductal union was not seen. This patient was the youngest case of bile duct carcinoma arising in choledochal cyst in Korea.

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담석과 관련이 없는 간내 담도의 국소적 협착을 가진 환자들에서의 담도경의 유용성 ( Usefulness of Cholangioscopy in Patients with Focal Stricture of the Intrahepatic Duct Unrelated to Intrahepatic Stones ): Korean J Gastrointest Endosc 2000;21(4):786-792. Published online November 30, 1999

Abstract PDF: Background
/Aims: Intrahepatic duct strictures are usually caused by intrahepatic duct stones and. cholangitis, However, focal strictures of the intrahepatic duct unrelated to intrahepatic stones often pose diagnostic problems. This study was undertaken to prospectively evaluate the usefuless of percutaneous transhepatic cholangioscopy in patients with a focal intrahepatic duct stricture and no evidence of a stone. Methods: Twenty two patients with a focal stricture of the intrahepatic duct not related to intrahepatic stones were included. Percutaneous transhepatic cholangioscopic examination including procurement of a biopsy specimen was performed after percutaneous transhepatic biliary drainage. Results: A histopathologic diagnosis was obtained in all patients (10 adenocarcinoma, 1 squamous cell carcinoma, 2 hepatocellular carcinoma, 2 adenoma and 7 benign strictures). Of the 10 patients with bile duct adenocarcinoma, 9 underwent surgery and a curative resection was possible in 8 patients (89%). Six patients (67%) had early-stage bile duct cancer in which the cancer invasion was limited to the mucosa or fibromuscular layer and there was no evidence of lymph node metastasis. Conclusions: Percutaneous transhepatic cholangioscopy in patients with focal stricture of the intrahepatic duct unrelated to choledocholithiasis seems to be very useful for the differential diagnosis including the detection of early bile duct cancer.

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증례 : 담도 췌장 ; 담관 점막 및 점막하를 따라 담낭 및 총간관으로 전이된 총 담관암 1예 ( Case Reports : Biliary Tract & Pancreas ; A Case of Common Bile Duct Cancer with Mucosal and Submucosal Spread to Gallbladder and Common Hepatic Duct ): Korean J Gastrointest Endosc 1997;17(6):872-877. Published online November 30, 1996

Abstract PDF: Cholangiocarcinoma is a form of adenocarcinoma arising from the intrahepatic or extra- hepatic biliary epithelium. Apparent predisposing factors include some chronic hepato- biliary parasitic infsttations, congenital anomalies with ectatic ducts, sclerosing cholangitis and chronic ulcerative colitis and occupational exposure to possible biliary tract carcinogens. Patients with cholangiocarcinoma usually present with biliary obstruction, painless jaundice, pruritus, weight loss and acholic stools. Because the obstructing process is gradua1, the cholangiocarcinoma is often far advanced by the time it presents clinically. The diagnosis is most frequently made by cholangiography following ultrasound demonstration of dilated intrahepatic bile ducts. We report a case of common bile duct cancer spreading to gallbladder and common hepatic duct along the biliary mucosal epitherium and submucosal tissue in 68-year-old female patient along with a review of literature. (Korean J Gastrointest Endosc 17: 872-877, 1997)

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