Percutaneous cholangiofiberscopic endoluminal forceps biopsy of intrabile duct diseases

BACKGROUND/AIMS: The aim of the present study was to determine the usefulne ss and sensitivity of percutaneous cholangiofiberscopic guided forceps biop sy in patients suspected of intrabile duct diseases. This study also emphas ized the use of a video monitor system in which the field of view is magnif ied; thus, even a small lesion can easily be detected. Furthermore, coordin ation of both the operator and assistant is easier because both can observe the image together on the video monitor. METHODOLOGY: Percutaneous cholangio-fiberscopic forceps biopsy was performe d in 27 patients (14 men, 13 women, aged 37-81 years with a mean age of 61 years). A mature T-tube tract was used as an access for cholangioscopy in 1 7 cases while the remaining 10 patients underwent percutaneous transhepatic biliary drainage and gradual tract dilatation from 7-French to 16-French. A flexible fiberoptic choledoscope was gently inserted into a mature tract and once an abnormal mucosal lesion was identified, a forceps biopsy was in serted into a working channel of the scope, and 3-5 specimens were taken fo r histological examination. RESULTS: A histological diagnosis was obtained in 24 cases of the 27 patien ts (sensitivity 89%) and included cholangiocarcinoma (n=8), papillomatosis (n=3), ampullary adenoma (n=1), ampullary adenocarcinoma (n=1), hepatoma wi th intrabile duct invasion (n=1), and chronic inflammation (n=10). Post-pro cedural bleeding was noted in 1 patient. CONCLUSIONS: Percutaneous cholangiofiberscopic-guided forceps biopsy is a s afe and easy to perform procedure. It yielded a high sensitivity rate for d efinitive diagnosis of very small or early intrabile duct lesions; thus, a curative therapeutic modality can be appropriately applied. The use of a vi deo monitor system, which magnified the field of view without distorting th e quality of the image, plays a crucial role in this technique. Mucin subst ance is commonly seen in cholangiocarcinoma. The association between bile d uct stones and neoplasm needs further evaluation.