Endoscopic application of photodynamic therapy for cholangiocarcinoma

Background: Previous studies indicate that photodynamic therapy provides ef fective relief from biliary obstruction in advanced cholangiocarcinoma, Thi s 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 wit h 2 mg/kg of sodium porfimer. Forty-eight hours later a commercially availa ble cylindrical diffusing laser fiber was inserted into an 8F biliary cathe ter equipped with a 0.038 inch side-hole at its distal tip. After positioni ng of a 0.035 inch guidewire proximal to the biliary stricture, the preload ed 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 Bi smuth 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 a ll patients. A fracture of the diffuser tip occurred during 1 of the treatm ents. Two patients developed acute cholangitis and 2 patients experienced s kin phototoxicity. Conclusions: Photodynamic therapy for cholangiocarcinoma is safe and techni cally feasible with a preloaded biliary catheter and a monorail technique f or catheter positioning.