Cholangioscopic management of intra hepatic papillomatosis unsuitable for surgical treatment


COD: 01_2009_035-38.pdf Categorie: ,

Luca Panier Suffa, Gianruggero Fronda, Valeria Maglione, Dorigo Righi, Andrea Doriguzzi, Alessandro Repici and Paolo De Paolis

Ann. Ital. Chir., 2009; 80: 35-38

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INTRODUCTION: Biliary papillomatosis can arise in any tract of the biliary three and is characterized by multiple papillary
proliferation of the epitelial cells.
CASE REPORT: A 65 years old woman was diagnosed been affected by biliary papillomatosis after many recourrent cholangitic
episodes. Liver transplantation was excluded because of neoplastic degeneration with systemic involvement. After
a percutaneous drainage and with palliative intent we performed an Argon plasma coagulation of the papillary lesions.
DISCUSSION: Clinical behaviour consists of recurrent cholangitic episodes and obstructive jaundice. There aren’t specific
radiological features, only mucobilia observed during an ERCP is pathognomonic. Biliary papillomatosis grow according
to the sequence adenoma-carcinoma with malignant transformation and poor prognosis due to multifocality and high
recurrence rate. Radical surgery and liver transplantation represents the gold standad. Among palliative procedures must
be considered percutaneous management with drainage and stenting, and intraluminal brachitherapy with I 192.
CONCLUSION: We propose a palliative treatment with cholangioscopic Argon plasma coagulation of the biliary lesions that
can be performed during a surgical exploration or a percutaneous management.