Abstract:

Objective

To evaluate the application value of ERCP combined with SpyGlass endoscopic radiofrequency ablation （RFA）+ photodynamic therapy （PDT）+ biliary stenting （BS） in advanced cholangiocarcinoma.

Methods

Clinical data of 1 patient with cholangiocarcinoma admitted to the Second Hospital of Lanzhou University in June 2023 were analyzed retrospectively.On June 13，2023， the 61-year-old female patient was admitted to the hospital due to “abdominal pain after eating for 1 month”.Physical examination： the skin mucosa and sclera were slightly yellow， and a firm and movable mass was palpable in the middle and upper abdomen and around the umbilicus.The left supraclavicular mass was approximately 2 cm×1 cm， without redness， swelling， pain and ulceration.Tumor markers：CA19-9＞1 000 kU/L， CEA 251 μg/L and CA72-4 32.8 kU/L.CT scan showed that the wall of the upper segment of common bile duct was slightly thickened and significantly enhanced.MRCP revealed that the circular thickening of the wall of common bile duct at the junction of the common hepatic duct and common bile duct， manifested as soft tissue shadow， which was considered as cholangiocarcinoma.Preliminary diagnosis of cholangiocarcinoma complicated with cervical lymph node metastasis was made.

Results

After comprehensive preoperative preparation， ERCP combined with SpyGlass endoscopic mucosal biopsy revealed signet ring cell carcinoma of the bile duct.A bare metal biliary stent （0.6 cm×1.0 cm） was implanted under endoscope combined with RFA and PDT.PDT was given once a day for 3 d.Postoperative adjuvant systemic therapy of albumin paclitaxel+capecitabine was delivered.After corresponding treatment， liver function indexes were significantly improved.CEA level was significantly declined from 251 μg/L to 169 μg/L.Repeated MRCP showed that the annular thickening of bile duct wall at the junction of the common bile duct and common bile duct was mitigated， and corresponding lumen stenosis and intrahepatic bile duct dilatation were also alleviated.

Conclusions

BS combined with RFA and PDT under ERCP provides a novel idea for comprehensive endoscopic treatment for patients with advanced cholangiocarcinoma， which will bring more benefits.

Key words: Bile duct neoplasms, Endoscopic retrograde cholangiopancreatography (ERCP), SpyGlass choledochoscopy, Biliary stenting, Radiofrequency ablation, Photodynamic therapy