Case Report
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Sep 7, 2013; 19(33): 5590-5592
Published online Sep 7, 2013. doi: 10.3748/wjg.v19.i33.5590
Photodynamic therapy for high-grade dysplasia of bile duct via a choledochoscope
Jiang-Jiao Zhou, Li Xiong, Qing-Long Li, Ying Gu, Yu Wen, Xiao-Feng Deng, Xiong-Ying Miao
Jiang-Jiao Zhou, Li Xiong, Qing-Long Li, Ying Gu, Yu Wen, Xiao-Feng Deng, Xiong-Ying Miao, Department of General Surgery, the Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
Ying Gu, Department of Laser Medicine, 301 Hospital, Beijing 100853, China
Author contributions: Zhou JJ and Xiong L contributed equally to this work. Zhou JJ and Xiong L designed the research and wrote the paper; Li QL, Gu Y, Wen Y and Deng XF performed the photodynamic therapy and collected data; Miao XY revised the manuscript; and all authors have read and approved the final version for submission.
Correspondence to: Xiong-Ying Miao, MD, Department of General Surgery, the Second Xiangya Hospital, Central South University, No. 139 Middle Renmin Road, Changsha 410011, Hunan Province, China. 13787782059@163.com
Telephone: +86-731-85295120 Fax: +86-731-85295121
Received: May 21, 2013
Revised: June 28, 2013
Accepted: July 12, 2013
Published online: September 7, 2013
Abstract

When a distal common bile duct neoplasm is at the stage of carcinoma in situ or high-grade dysplasia, it is difficult for the surgeon to decide whether to perform pancreaticoduodenectomy. Here we describe a patient with a progressive dysplastic lesion in the common bile duct, which developed from moderate-high to high-grade dysplasia in approximately 2 mo. The patient refused major surgery. Therefore, endoscopic-assisted photodynamic therapy was performed. The result at follow-up using a trans-T-tube choledochoscope showed that the lesion was completely necrotic. This report is the first to describe the successful treatment of high-grade dysplasia of the distal bile duct using photodynamic therapy via a choledochoscope.

Keywords: Photodynamic therapy, Common bile duct, High-grade dysplasia, Choledochoscope

Core tip: Due to significant surgical trauma and a low risk of canceration, surgeons face a dilemma regarding the decision to perform pancreaticoduodenectomy for high-grade dysplasia of the distal bile duct. This report is the first to describe the successful treatment of high-grade dysplasia of the distal bile duct using photodynamic therapy via a choledochoscope. This clinical case demonstrated that photodynamic therapy via a trans-T-tube choledochoscope may be an effective and promising protocol for carcinoma in situ or high-grade dysplasia of the distal common bile duct.