Multidisciplinary Treatment of Aggressive and Rapidly Progressing Biliary Papillomatosis

Excerpt

A 65-year-old man was admitted to our hospital in 2004 with painless jaundice due to a severe cholangitis. Ultrasound did not reveal bile duct dilatation, signs of cholecystitis, or stones. Laboratory tests detected leucocytosis, direct bilirubinemia (44 U/l), and elevated transaminases (AST 144 U/l). Endoscopic retrograde cholangiography (ERC) revealed no relevant stenosis. After a few days of biliary irrigation and intravenous antibiotic treatment, our patient was able to leave the hospital, further diagnostic was not performed at that time. Eleven months later, recurrent cholangitis led to a second admission. Diagnosis of a slight suprahilar stenosis of the left bile duct required stent-insertion (Figs. 1a, 2a). Endoscopically gained suprahilar biopsies confirmed papillary adenoma with low-grade intraepithelial neoplasia (IEN). Regular changes of stents were performed every 3 months. Progressive obstruction of intrahepatic as well as extrahepatic bile ducts required stent therapy of main ducts in both liver lobes. High-grade IEN was not confirmed in any examination. About 3 years from the first admission, nearly the whole biliary tree and the upper two-thirds of the main duct were affected (Figs. 1b, 2b, c). A further episode of cholangitis could not be managed endoscopically, therefore a percutaneous drainage was inserted.

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