Placement of ¹²⁵I seed strands and stents for a type IV Klatskin tumor

Abstract

Herein, we report a new technique that consists of placing two (125)I seed strands and two stents in the right and left intrahepatic bile ducts for the treatment of hilar cholangiocarcinoma. A 75-year-old man presented with jaundice and was diagnosed with Bismuth type IV Klatskin tumor. Abdominal computed tomography (CT) showed intrahepatic and extrahepatic bile duct dilatation and a soft tissue mass in the hepatic hilum. Because curative surgical resection was not possible, we placed (125)I seed strands and stents in the right and left intrahepatic bile ducts. Three months later, abdominal CT showed less intrahepatic and extrahepatic bile duct dilatation than before the procedure. This technique was feasible and could be considered for the treatment of patients with Bismuth type IV tumors.

Keywords: 125I seed strands; Bile duct; Bismuth type IV; Cholangiocarcinoma; Klatskin tumor; Stent.

Figure 1

A 75-year-old man with a Bismuth type IV Klatskin tumor was treated via the placement of ¹²⁵I seed strands and stents in the right and left intrahepatic bile ducts. A: An 8.5-F external catheter (arrow) was placed for biliary drainage before placement of the ¹²⁵I seed strands and stents; B: The stent delivery systems and ¹²⁵I seed strands (arrow) were advanced over the wires to the sites of the obstruction. The stents were then deployed simultaneously, followed by placement of the ¹²⁵I strands; C: Abdominal CT at 3 mo after the procedure. The results showed mild dilatation of the intrahepatic bile ducts (arrow), and the stents remained patent. CT: Computed tomography.