Ann Surg Treat Res.  2017 Sep;93(3):125-129. 10.4174/astr.2017.93.3.125.

Effectiveness of cholangioscopy using narrow band imaging for hepatobiliary malignancies

• Jang JW
• Noh DH
• Paik KH
• Kim SH
• Paik IH
• Jung SH

• KMID: 2398958
• DOI: http://doi.org/10.4174/astr.2017.93.3.125

Abstract

PURPOSE
Recently, cholangioscopy using narrow band imaging (NBI) has been used as a diagnostic modality for better visualization in hepatobiliary malignancies; however, there are few reports on it. Our aim is to evaluate the effectiveness of cholangioscopy using NBI in hepatobiliary malignancies.
METHODS
Between January 2007 and December 2016, 152 cholangioscopies using percutaneous approach were conducted in total 123 patients. Among these, 36 patients were suspicious of hepatobiliary malignancies. Thirteen patients with an ambiguous margin on endoscopic retrograde cholangiopancreatography (ERCP) or magnetic resonance cholangiopancreatography (MRCP), for whom NBI tipped the balance in diagnosis of lesion and decision of lesion extent by adding NBI, were involved in our study.
RESULTS
Underlying diseases were all malignant in 13 patients (11 bile duct cancers, 1 liver cancer, 1 pancreas cancer with common bile duct invasion). In 7 cases with papillary type tumor, minute superficial spreading tumor was detected by NBI more easily, and NBI provided a better visualization of tumor vessel and margin evaluation in 4 cases with infiltrative tumor. In 2 cases with mucin-hypersecreting tumor, NBI showed better penetration through the mucin and gave us a much clearer image. Nine patients ultimately underwent surgical resection. The margins predicted by NBI cholangioscopy were consistent with the pathological margins on the resected specimens.
CONCLUSION
In conclusion, cholangioscopy using NBI is very useful for evaluation of suspected hepatobiliary malignancies with an ambiguous margin on ERCP or MRCP. It can give us an accurate pathologic mapping, and this information seems to be essential before deciding on a treatment strategy.

Keyword

Cholangiography; Narrow band imaging

MeSH Terms

Bile Duct Neoplasms
Cholangiography
Cholangiopancreatography, Endoscopic Retrograde
Cholangiopancreatography, Magnetic Resonance
Common Bile Duct
Diagnosis
Humans
Liver Neoplasms
Mucins
Narrow Band Imaging*
Pancreatic Neoplasms
Mucins

Figure

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  Fig. 1 Papillary type cancer. (A) Minute papillary mucosal changes (arrows) were suspected at this level of bile duct. But, the border of lesion was ambiguous. (B) With narrow band imaging, a prominent papillary lesion (arrowheads) was noted at the same level.

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  Fig. 2 Infiltrative type cancer. (A) Conventional white-light imaging showed a tapered, luminal narrowing of the common hepatic duct and neovascularization of its surface. (B) After narrow band imaging, more irregular mucosal surface, color change on the tumor vessel, and more vascular changes especially on the tumor margin were noted.

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  Fig. 3 Mucin-hypersecreting type tumor. (A) White-light imaging showed floating mucinous material, however, we could not identify any mucosal change because of the large amount of mucin. (B) On narrow band imaging, both mucin and the tumor mass were clearly visible.

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