Cholangioscopic management of intra hepatic papillomatosis unsuitable for surgical treatment

Abstract

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.