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Case Reports
. 2007 Nov 7;13(41):5512-5.
doi: 10.3748/wjg.v13.i41.5512.

Histological changes at an endosonography-guided biliary drainage site: a case report

Naotaka Fujita  1 , Yutaka Noda, Go Kobayashi, Kei Ito, Takashi Obana, Jun Horaguchi, Osamu Takasawa, Kazunari Nakahara
Affiliations
Case Reports

Histological changes at an endosonography-guided biliary drainage site: a case report

Naotaka Fujita et al. World J Gastroenterol. .

Abstract

Endosonography-guided biliary drainage (ESBD) is a new method enabling internal drainage of an obstructed bile duct. However, the histological conditions associated with fistula development via the duodenum to the bile duct have not been reported. We performed ESBD 14 d preoperatively in a patient with an ampullary carcinoma and histologically confirmed changes in and around the fistula. The female patient developed no complications relevant to ESBD. Levels of serum bilirubin and hepatobiliary enzymes declined quickly, and pancreatoduodenectomy was carried out uneventfully. The resected specimen was sliced and stained with hematoxylin-eosin. Histological evaluation of the puncture site in the duodenum and bile-duct wall, and the sinus tract revealed no hematoma, bile leakage, or abscess in or around the sinus tract. Little sign of granulation, fibrosis, and inflammatory cell infiltration was observed. Although further large-scale confirmatory studies are needed, the findings here may encourage more active use of ESBD as a substitute for percutaneous transhepatic drainage in cases with failed/difficult endoscopic biliary stenting.

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Figures

Figure 1
Figure 1
CT reveals a mass in the ampullary region (arrow) with a dilated extrahepatic bile duct. The patient also had multiple renal cysts.
Figure 2
Figure 2
A, B: Puncture of the bile duct via the duodenum under endosonographic guidance, followed by deployment of a plastic stent. C: Endoscopic view after stent placement.
Figure 3
Figure 3
Fresh resected specimen. No hematoma or abscess is seen at the site of the puncture in the bile duct.
Figure 4
Figure 4
Microscopic views of the sinus tract. Mild inflammatory cell infiltrate adjacent to the sinus tract in the duodenal wall and the bile duct wall is seen, without hemorrhage or abscess formation. A fistula is formed along the tract of the puncture but without significant reactive changes. A: Low-power view of the sinus tract (× 1.25); B: End of the sinus tract on the bile duct side (× 5); C: End of the sinus tract on the duodenal side (× 5).
See this image and copyright information in PMC

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