| Theme |
Hilar and Intrahepatic Cholangiocarcinoma |
| Title |
Diagnosis of Hilar Bile Duct Cancer through Cholangiography and Cholangioscopy |
| Author |
Yoshihide Kanno |
Department of Gastroenterology, Sendai City Medical Center |
| Author |
Naotaka Fujita |
Department of Gastroenterology, Sendai City Medical Center |
| Author |
Yutaka Noda |
Department of Gastroenterology, Sendai City Medical Center |
| Author |
Go Kobayashi |
Department of Gastroenterology, Sendai City Medical Center |
| Author |
Kei Ito |
Department of Gastroenterology, Sendai City Medical Center |
| Author |
Jun Horaguchi |
Department of Gastroenterology, Sendai City Medical Center |
| [ Summary ] |
It is difficult to accurately determine the operability of hilar cholangiocarcinoma due to the anatomical complexity of the hepatic hilum. Accurate preoperative diagnosis requires appropriate order and extreme precision of examination. Direct cholangiography should be performed after non-invasive examinations such as CTs or MRIs, the findings of which should be carefully interpreted, especially focusing on the longitudinal spread of cancer. Endoscopic biliary decompression is preferable to percutaneous drainage because the latter carries a risk of needle tract seeding or peritoneal dissemination of cancer cells. With endoscopic biliary stenting an internal drainage opening to the duodenum may cause cholangitis due to the reflux of duodenal fluids via the stent into the bile duct. Therefore, decompression should be performed through nasobiliary drainage, which allows for cholangiography later. Cholangioscopy is performed when there is a discrepancy between the imaging diagnoses and mapping biopsy findings and when it is difficult to obtain mapping biopsy materials. Peroral cholangioscopy is useful in the diagnosis of intraepithelial cancer spreading, although it is sometimes difficult to observe the bile duct proximal to the main tumor. |