Case Report
Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Jul 14, 2008; 14(26): 4234-4237
Published online Jul 14, 2008. doi: 10.3748/wjg.14.4234
Successful photodynamic therapy for biliary papillomatosis: A case report
Lars P Bechmann, Philip Hilgard, Andrea Frilling, Brigitte Schumacher, Hideo A Baba, Guido Gerken, Thomas Zoepf
Lars P Bechmann, Philip Hilgard, Guido Gerken, Thomas Zoepf, Department of Gastroenterology and Hepatology, University Hospital Essen, Essen D-45122, Germany
Andrea Frilling, Department of General-, Visceral- and Transplant Surgery, University Hospital Essen, Essen D-45122, Germany
Brigitte Schumacher, Department of Internal Medicine, Evangelisches Krankenhaus, Duesseldorf D-40217, Germany
Hideo A Baba, Department of Pathology, University Hospital Essen, Essen D-45122, Germany
Author contributions: Bechmann LP, Hilgard P, Gerken G, Schumacher B and Zoepf T were involved in primary care of the patient and performed the PDT; Baba HA evaluated the histological findings and revised the manuscript; Frilling A was involved in surgical consultations and revised the manuscript; Bechmann LP and Zoepf T wrote the paper
Correspondence to: Thomas Zoepf, MD, Department of Medicine, Division of Gastroenterology and Hepatology, University of Essen, Hufeland street 55, Essen D-45122, Germany. thomas.zoepf@uk-essen.de
Telephone: +49-201-72384714
Fax: +49-201-7235745
Received: January 8, 2008
Revised: June 3, 2008
Accepted: June 10, 2008
Published online: July 14, 2008
Abstract

Papillomatosis of the bile duct is a rare disease with a high risk of malignant transformation. Therapeutical options include partial hepatectomy and liver transplantation. A previously healthy 65-years old male developed jaundice and right upper abdominal quadrant pain in 1996. A villous adenoma of the distal bile duct was diagnosed. A Whipple procedure was performed. In 2002 the patient turned symptomatic again. Another adenoma was found in the right hepatic duct resulting in a right hepatectomy. Two years later the patient again developed cholestasis. After drainage of the left hepatic duct with a percutaneous transhepatic cholangial drainage (PTCD) catheter, a recurrent biliary adenomatosis was diagnosed by cholangioscopy. As there was no surgical option left, the patient received photodynamic therapy (PDT) for the recurrent biliary papillomatosis. Three mo after he received further photodynamic therapies, the bile duct epithelium appeared normal and the patient had no signs of adenomatosis, both macroscopically and histologically. The follow-up cholangioscopy in late 2005 revealed only a small papilloma without the need for intervention. In early 2006, the patient died of multi organ failure without signs of extrahepatic cholestasis or cholangitis at the age of 75, 10 years after the diagnosis of biliary papillomatosis was established. The patient exceeded the average life expectancy of patients with biliary papillomatosis by far. Thus, PDT might be a sufficient therapeutic option for recurrent papillomatosis patients with no significant side effects.

Keywords: Biliary papillomatosis; Cholangioscopy; Photodynamic therapy