Clinical feasibility of direct peroral cholangioscopy–guided photodynamic therapy for inoperable cholangiocarcinoma performed by using an ultra-slim upper endoscope (with videos) - 11/08/11
Reprint requests: Jong Ho Moon, MD, PhD, Soon Chun Hyang University School of Medicine, Digestive Disease Center, Soon Chun Hyang University Bucheon Hospital, 1174 Jung-Dong, Wonmi-Ku, Bucheon 420-767, KoreaRésumé |
Background |
Photodynamic therapy (PDT) has emerged as a promising palliative treatment for inoperable cholangiocarcinoma. Cholangioscopy-guided PDT can be useful for identification of tumor margins, determination of the appropriate location for placement of the diffuser, and evaluation of the patient's response to therapy.
Objective |
To evaluate the feasibility of PDT under direct peroral cholangioscopy (POC) by using an ultra-slim upper endoscope in patients with inoperable cholangiocarcinoma.
Design |
Prospective, observational, pilot study.
Setting |
Single tertiary-care referral center.
Patients |
This study involved 9 patients with inoperable extrahepatic cholangiocarcinoma.
Intervention |
Photofrin II was administered intravenously 48 hours before PDT. Additional PDT was performed up to 48 hours after the initial application of therapy. A successful direct POC–guided PDT was defined as advancement of the endoscope into the distal margin of the tumor and maintenance of endoscope position until PDT was completed.
Main Outcome Measurements |
The clinical feasibility, usefulness, and complications of direct POC for PDT.
Results |
Seventeen sessions of direct POC for PDT were performed in 9 patients. PDT was performed successfully in 15 of 17 sessions (88.2%) and 7 of 9 patients (77.8%). Biliary drainage under direct POC, if necessary after PDT, was possible in 100% of patients (7/7). Follow-up direct POC confirmed significant tumor ablation after PDT in 5 patients. One patient reported mild skin redness; no major procedure-related complications were observed.
Limitations |
Small sample size, pilot study.
Conclusion |
Direct POC–guided PDT by using an ultra-slim upper endoscope seems to be both feasible and safe in select patients with inoperable extrahepatic cholangiocarcinoma.
Le texte complet de cet article est disponible en PDF.Abbreviations : PDT, POC
Plan
| DISCLOSURE: Olympus Korea Co, Ltd. provided an ultra-slim upper endoscope for this study, and LitePharmTech Co, Ltd gave technical support. No other financial relationships relevant to this publication were disclosed. |
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| If you would like to chat with an author of this article, you may contact Dr Moon at jhmoon@schmc.ac.kr. |
Vol 73 - N° 4
P. 808-813 - avril 2011 Retour au numéro
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