title: Clinical feasibility of direct peroral cholangioscopy-guided photodynamic therapy for inoperable cholangiocarcinoma performed by using an ultra-slim upper endoscope (with videos).
abstract: BACKGROUND
  Photodynamic therapy (PDT) has emerged as a promising palliative treatment for inoperable cholangiocarcinoma. Cholangioscopy-guided PDT can be useful for identification of tumor margins, determination of the appropriate location for placement of the diffuser, and evaluation of the patient's response to therapy.
  
  
  OBJECTIVE
  To evaluate the feasibility of PDT under direct peroral cholangioscopy (POC) by using an ultra-slim upper endoscope in patients with inoperable cholangiocarcinoma.
  
  
  METHODS
  Prospective, observational, pilot study.
  
  
  METHODS
  Single tertiary-care referral center.
  
  
  METHODS
  This study involved 9 patients with inoperable extrahepatic cholangiocarcinoma.
  
  
  METHODS
  Photofrin II was administered intravenously 48 hours before PDT. Additional PDT was performed up to 48 hours after the initial application of therapy. A successful direct POC-guided PDT was defined as advancement of the endoscope into the distal margin of the tumor and maintenance of endoscope position until PDT was completed.
  
  
  METHODS
  The clinical feasibility, usefulness, and complications of direct POC for PDT.
  
  
  RESULTS
  Seventeen sessions of direct POC for PDT were performed in 9 patients. PDT was performed successfully in 15 of 17 sessions (88.2%) and 7 of 9 patients (77.8%). Biliary drainage under direct POC, if necessary after PDT, was possible in 100% of patients (7/7). Follow-up direct POC confirmed significant tumor ablation after PDT in 5 patients. One patient reported mild skin redness; no major procedure-related complications were observed.
  
  
  CONCLUSIONS
  Small sample size, pilot study.
  
  
  CONCLUSIONS
  Direct POC-guided PDT by using an ultra-slim upper endoscope seems to be both feasible and safe in select patients with inoperable extrahepatic cholangiocarcinoma.
authors.affiliation: Digestive Disease Center, Department of Internal Medicine, Soon Chun Hyang University School of Medicine, Bucheon and Seoul, Korea.
authors.forename: Hyun Jong
authors.initials: HJ
authors.lastname: Choi
authors.forename: Jong Ho
authors.initials: JH
authors.lastname: Moon
authors.forename: Bong Min
authors.initials: BM
authors.lastname: Ko
authors.forename: Seul Ki
authors.initials: SK
authors.lastname: Min
authors.forename: A Ri
authors.initials: AR
authors.lastname: Song
authors.forename: Tae Hoon
authors.initials: TH
authors.lastname: Lee
authors.forename: Young Koog
authors.initials: YK
authors.lastname: Cheon
authors.forename: Young Deok
authors.initials: YD
authors.lastname: Cho
authors.forename: Sang-Heum
authors.initials: SH
authors.lastname: Park
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000188:drug therapy* / Q000473:pathology; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000188:drug therapy* / Q000473:pathology; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D017323:Dihematoporphyrin Ether / Q000627:therapeutic use; D019723:Endoscopes; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008904:Miniaturization; D009367:Neoplasm Staging; D010166:Palliative Care / Q000379:methods*; D010778:Photochemotherapy / Q000379:methods*; D017319:Photosensitizing Agents / Q000627:therapeutic use; D010865:Pilot Projects; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D017319:Photosensitizing Agents; D017323:Dihematoporphyrin Ether