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Case Report
- High-Resolution Probe-Based Confocal Laser Endomicroscopy for Diagnosing Biliary Diseases
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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
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Abstract
PDF - 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 “CholangioFlexTM”, 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: CholangioFlexTM, GastroFlexTM, and AlveoFlexTM. With GastroFlexTM, the clear mucosal epithelium was observed, and differential diagnoses as benign/malignant could be made based on epithelial findings. GastroFlexTM 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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Citations
Citations to this article as recorded by
- Challenges and Prospects of Using Novel Nonlinear Effects in Multimode Optical Fibers for Multiphoton Endomicroscopy
Lidiya V. Boldyreva, Denis S. Kharenko, Kirill V. Serebrennikov, Anna A. Evtushenko, Viktor V. Shloma, Daba A. Radnatarov, Alexandr V. Dostovalov, Zhibzema E. Munkueva, Oleg S. Sidelnikov, Igor S. Chekhovskoy, Kirill S. Raspopin, Mikhail D. Gervaziev, Ste
Diagnostics.2026; 16(3): 438. CrossRef - Early detection of biliary adenocarcinoma using probe-based confocal laser endomicroscopy: a case report
Jiangshan Wu
American Journal of Cancer Research.2025; 15(6): 2642. CrossRef - Intraductal papillary neoplasm of the biliary tract with typical clinicopathological, endoscopic features: A case report
Tian-Yuan Gu, Su-Hang Wang, Shu-Ying Yang, Si-Qi Zhao, Min-Jie Chen, Xiao-Ping Li, Zheng-Wei Song, Xiao-Xia Gu, Fei Chen
World Journal of Gastrointestinal Surgery.2025;[Epub] CrossRef - 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 - A Comparative Analysis of Artificial Intelligence-based Digital Cholangioscopy and Probe-based Confocal Laser Endomicroscopy for Detecting Malignant Bile Duct Lesions: A single-centre retrospective study
C. Robles-Medranda, J. Baquerizo-Burgos, M. Puga-Tejada, D. Cunto, M. Egas-Izquierdo, M. Arevalo-Mora, J. C. Mendez, J. Alcivar-Vasquez, H. Alvarado-Escobar, H. Pitanga-Lukashok, D. Tabacelia
Endoscopy.2023; 55(S 02): S134. CrossRef
- Challenges and Prospects of Using Novel Nonlinear Effects in Multimode Optical Fibers for Multiphoton Endomicroscopy
- 6,908 View
- 95 Download
- 5 Web of Science
- 5 Crossref
Original Article
- Inside Plastic Stents versus Metal Stents for Treating Unresectable Malignant Perihilar Biliary Obstructions: A Retrospective Comparative Study
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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
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Abstract
PDF
- 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. -
Citations
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DEN Open.2026;[Epub] CrossRef - Clinical utility of suprapapillary plastic stents for lifelong biliary drainage in unresectable malignant hilar biliary obstruction
Hisahiro Uemura, Takashi Kobayashi, Atsuhiro Masuda, Kenta Yamamoto, Kaoruko Kanamaru, Takafumi Tokunaga, Akira Shirohata, Tetsuhisa Ko, Yusuke Yokotani, Yuki Oka, Yosuke Irie, Noriko Juri, Yoshiyuki Harada, Mika Miki, Noriko Inomata, Kae Nagao, Shinya Ko
Gastrointestinal Endoscopy.2026; 103(3): 475. CrossRef - The selection and strategy of stents in endoscopic drainage of unresectable perihilar cholangiocarcinoma: a meta-analysis
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BMC Surgery.2026;[Epub] CrossRef - Unilateral drainage and chemotherapy prolong the patency of a plastic stent placed above the sphincter of Oddi in patients with malignant hilar biliary obstruction
Fumimasa Tomooka, Koh Kitagawa, Akira Mitoro, Yukihisa Fujinaga, Norihisa Nishimura, Tadashi Namisaki, Takemi Akahane, Kosuke Kaji, Shohei Asada, Shinya Sato, Jun‐Ichi Hanatani, Hitoshi Mori, Yuki Motokawa, Tomihiro Iwata, Hiroki Kachi, Yui Osaki, Hitoshi
DEN Open.2025;[Epub] CrossRef - Evaluating safety and efficacy of plastic versus metal stenting in malignant hilar biliary obstruction: a systematic review and meta-analysis of randomized controlled trials
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Postgraduate Medical Journal.2025; 101(1195): 447. CrossRef - Development and application of an early warning model for predicting early mortality following stent placement in malignant biliary obstruction: A comparative analysis of logistic regression and artificial neural network approaches
Yongxin Ma, Jiaojiao Qi, Xusheng Zhang, Kejun Liu, Yimin Liu, Xuehai Yu, Yang Bu, Bendong Chen
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Mitsuru Okuno, Keisuke Iwata, Tsuyoshi Mukai, Yuhei Iwasa, Shinya Uemura, Kensaku Yoshida, Akinori Maruta, Takuji Iwashita, Ichiro Yasuda, Masahito Shimizu
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
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- Efficacy of Drainage Combining Endoscopic Retrograde Cholangiopancreatography With Endoscopic Ultrasound‐guided Biliary Drainage for Difficult‐to‐Control Cholangitis in Patients With Hilar Cholangiocarcinoma
- 9,597 View
- 303 Download
- 28 Web of Science
- 28 Crossref
- 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
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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
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Abstract
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- 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
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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
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Abstract
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- 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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