L ong-term survival after palliative argon plasma coagulation for intraductal papillary mucinous neoplasm of the bile du
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CASE REPORT
Long‑term survival after palliative argon plasma coagulation for intraductal papillary mucinous neoplasm of the bile duct Junya Arai1 · Jun Kato1 · Nobuo Toda1 · Ken Kurokawa1 · Chikako Shibata1 · Shigeyuki Kurosaki1 · Kazuyoshi Funato1 · Mayuko Kondo1 · Kaoru Takagi1 · Kentaro Kojima1 · Masataka Ohki1 · Michiharu Seki1 · Kazumi Tagawa1 Received: 15 December 2019 / Accepted: 25 July 2020 © Japanese Society of Gastroenterology 2020
Abstract Intraductal papillary mucinous neoplasm of the bile duct (IPNB) is an epithelial tumor that can cause obstructive jaundice and cholangitis due to mucin production. Although the effectiveness of argon plasma coagulation in IPNB treatment has been demonstrated, the long-term effect of the therapy is largely unknown. Here, we have presented a patient with IPNB who underwent argon plasma coagulation with a follow-up period of more than 2 years. A 74-year-old woman was referred to our department for treatment of obstructive jaundice. Endoscopic retrograde cholangiopancreatography revealed marked dilation of intrahepatic and extrahepatic bile ducts and thick mucin drainage from the ampulla of Vater. IPNB was diagnosed pathologically from biopsy specimens. Surgery was not recommended because of the extensive intrahepatic spread of the lesion. Endoscopic sphincterotomy, endoscopic papillary large balloon dilation, and insertion of a metallic stent could not resolve the obstructive jaundice. Finally, argon plasma coagulation with percutaneous cholangioscopy was performed 3 times over 1 month. After treatment, obstructive jaundice was resolved and the patient’s clinical condition has been stable for more than 2 years, except for a single episode of transient cholangitis. In conclusion, argon plasma coagulation may be an alternative to surgery for the palliation of jaundice with IPNB. Keywords Intraductal papillary mucinous neoplasm of the bile duct · Cholangioscopy · Argon plasma coagulation Abbreviations IPNB Intraductal papillary mucinous neoplasm of the bile duct APC Argon plasma coagulation RFA Radiofrequency ablation
Introduction Intraductal papillary mucinous neoplasm of the bile duct (IPNB) is an epithelial tumor that can cause obstructive jaundice and cholangitis due to mucin production [1]. This rare type of tumor resembles its counterpart, the intraductal papillary mucinous neoplasm of the pancreas [2]. According to the World Health Organization Classification of Tumors
of the Digestive System (4th edition, 2010), this disease is the precancerous stage of cholangiocarcinoma [3]. Surgery is the first-choice treatment for this disease, and the prognosis after surgical resection is relatively good [4]. However, for several reasons, surgery is not always recommended. Those reasons include extensive intrahepatic spread of the tumor, the patient’s physical condition, and severe comorbidities. Although several previous reports have shown the possible palliative effectiveness of argon plasma coagulation (APC) in the control of obstructive jaundice or cholangitis due t
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