Endoscopic application of photodynamic therapy for cholangiocarcinoma.

Abstract

BACKGROUND:

Previous studies indicate that photodynamic therapy provides effective relief from biliary obstruction in advanced cholangiocarcinoma. This report describes a method of applying photodynamic therapy in the biliary tract by using accessories available in the United States.

METHODS:

Endoscopic retrograde cholangiography was performed to define the proximal and distal extent of intraductal tumor. Patients were injected with 2 mg/kg of sodium porfimer. Forty-eight hours later a commercially available cylindrical diffusing laser fiber was inserted into an 8F biliary catheter equipped with a 0.038 inch side-hole at its distal tip. After positioning of a 0.035 inch guidewire proximal to the biliary stricture, the preloaded catheter was advanced over the guidewire by using the monorail technique. Laser light was applied at a power of 400 mW/cm fiber for a total energy of 180 J/cm.(2)

RESULTS:

Fourteen treatments were performed on 6 patients with tumors of Bismuth types IV (n = 2), III (n = 3), or II (n = 1). By using the preloaded biliary catheter, adequate positioning of the laser fiber was achieved in all patients. A fracture of the diffuser tip occurred during 1 of the treatments. Two patients developed acute cholangitis and 2 patients experienced skin phototoxicity.

CONCLUSIONS:

Photodynamic therapy for cholangiocarcinoma is safe and technically feasible with a preloaded biliary catheter and a monorail technique for catheter positioning.

• Authors: A Rumalla, T H Baron, K K Wang, G J Gores, L M Stadheim, P C de Groen
• Journal: Gastrointestinal endoscopy (Gastrointest Endosc) Vol. 53 Issue 4 Pg. 500-4 (Apr 2001) ISSN: 0016-5107 [Print] United States
• PMID: 11275896 (Publication Type: Case Reports, Clinical Trial, Journal Article)

Chemical References

• Bilirubin

Topics

• Adult
• Aged
• Bile Duct Neoplasms (diagnostic imaging, drug therapy, metabolism)
• Bile Ducts, Intrahepatic
• Bilirubin (blood)
• Cholangiocarcinoma (diagnostic imaging, drug therapy, metabolism)
• Cholangiopancreatography, Endoscopic Retrograde (adverse effects, methods)
• Humans
• Lasers
• Liver Function Tests
• Middle Aged
• Photochemotherapy (methods)
• Quality of Life
• Radiography, Interventional (adverse effects, methods)