Biliary
papillomatosis is rare, and its pathogenic mechanisms are not yet clear. Because of its high risk for
malignancy transformation, surgical resection is regarded as a standard treatment.
Photodynamic therapy (
PDT) has been used by the
intravenous administration of
hematoporphyrin derivative followed by
laser exposure. A photochemical process causes disturbance of the microvascular structure and degradation of membrane.
Cholangitis is a major complication after
PDT. A healthy 56-year-old man was diagnosed with biliary
papillomatosis involving the common hepatic duct, both proximal intrahepatic bile ducts (IHD), and the right posterior IHD. After biliary
decompression by endoscopic nasobiliary drainage,
PDT was performed to avoid extensive liver resection and recurrence using endoscopic retrograde cholangiographic guidance. After portal vein embolization, the patient underwent extended right hemihepatectomy. Following administration of chemoradiation
therapy with
tegafur-
uracil and 45 Gy due to local recurrence at postoperative 13 months, there was no local recurrence or distant
metastases. This is the first case report on
PDT for biliary
papillomatosis in Korea. Preoperative
PDT is beneficial for reducing the lesion in diffuse or multifocal biliary
papillomatosis and may lead to curative and volume reserving surgery. Thus,
PDT could improve the quality of life and prolong life expectation for biliary
papillomatosis patients.