Intraductal ultrasonography (IDUS) is one of the most useful intraductal modalities for investigating the structure of the biliary wall layers and for the presence of stones during endoscopic retrograde cholangiography (ERC) [1] [2] [3]. In patients with pneumobilia, however, conventional IDUS is significantly limited in its ability to provide accurate cross-sectional imaging.
With the development of newer devices and technical innovations, pancreaticobiliary endoscopy is expanding to assume more advanced therapeutic roles. As with other devices, slimmed-down "3-Fr microcatheters" are considered to be opening new windows toward entirely new therapeutic techniques for various purposes. Our practical experience with a total of 34 consecutive patients in whom 3-Fr microcatheters were applied during pancreaticobiliary endoscopic procedures clarified the potential roles of this instrument in pancreaticobiliary endoscopy. The major benefits of 3-Fr microcatheters involve their slimness and flexibility. Applications of 3-Fr microcatheters could be categorized into three groups according to the characteristics of usage: (1) utilization as a cannulation catheter for peroral digital cholangioscopy (n = 15); (2) selective advancement through deep flexures or severely stenotic ducts (n = 11); or (3) two-devices-in-one-channel technique (n = 8). The microcatheter worked successfully for cannulation of cholangioscopy in all but one case (14/15, 93.3%). For selective advancement, the microcatheter worked for troubleshooting in 9 of 11 cases (81.8%). With the two-devices-in-one-channel technique, the microcatheter proved satisfactory in all cases (8/8, 100%). In total, the microcatheter was successfully maneuvered in 31 of 34 cases (91.1%), following the failure of procedures using conventional endoscopic techniques. In terms of adverse events, cystic duct injury was only observed in two cases (5.8%), who recovered under conservative observation, because its slimness could minimize the damage. We believe that 3-Fr microcatheters offer effective and safe salvage troubleshooting during various endoscopic pancreaticobiliary procedures that face troublesome situations with conventional strategies.
For unresectable malignant hilar biliary obstructions, drainage of ≥ 50 % of the liver volume is recommended [1]. Endoscopic transpapillary biliary drainage is the current standard treatment for malignant hilar biliary obstruction. Cholangioscopy-assisted guidewire placement is a useful method for biliary drainage, which can be used even in patients without contrast-filled images [2]
Bile leakage after hepatectomy has been reported to occur in 5 %–8 % of cases [1] [2]. In particular, isolated bile leakage is intractable and may require surgical re-anastomosis. In general, endoscopic treatment for isolated bile leakage by transpapillary biliary drainage for recanalization is challenging [3]; the procedure is often unsuccessful because of surgically altered anatomy and disconnection of the bile duct. Here, we report a case of successful endoscopic ultrasound (EUS)-guided biliary recanalization for isolated bile leakage that employed a novel approach assisted by rendezvous balloon inflation.
<p>Supplementary Figure S1: Cell viability in pancreatic cancer cells treated by talaporfin with or without irradiation. Supplementary Figure S2: The luciferase luminescence intensities in AsPC1/luc cells treated by PDT with talaporfin or Mal3-chlorin. Cells were treated with talaporfin (1-16 μM) or Mal3-chlorin (0.1-2 μM) at 37{degree sign}C for 4 h, and then irradiated. After incubation for 24 h, cells were incubated for a short time at 37{degree sign}C with D-luciferin (150 μg/mL, Wako, Ltd.) in media. Luminescence was measured using a Lu mat LB 9507 instrument (EG&G BERTHOLD) and the data were normalized against the average value of non-treated cells. Values are means {plus minus} SD, n = 4 in each. Supplementary Figure S3: Average body weight transitions of mice during the experiment. Values are means {plus minus} SD, n = 7 in each. Supplementary Figure S4: Images of representative abdominal skin of mice from each group. Representative imaging of abdominal skin from mice at day 1, 8, and 15 on the treatment regimen as shown in Figure 4A: Control mice (left panel), talaporfin-mediated PDT mice (middle panel), and Mal3-chlorin-mediated PDT mice (right panel). Supplementary Figure S5: Involvement of GLUT1 in the uptake of Mal3-chlorin into pancreatic cancer cells. AsPC1/luc or BxPC3/luc cells were seeded into 96-well culture plates at a concentration of 5 Ã- 103 cells/well and incubated overnight. Cells were subsequently treated with WZB117 (0.1-30 μM; EMD Chemicals, San Diego, CA, USA), which is a pharmacological GLUT1 inhibitor. After incubation for 24 h, cells were incubated for 4 h with Mal3-chlorin (1 μM) and WZB117 (0.1-30 μM), and levels of specific fluorescence were measured by Spectrafluor Plus (excitation; 405 nm, emission; 660 nm). The data were normalized against the average value of non-treated cells. Values are means {plus minus} SD, n = 6 in each. Supplementary Figure S6: Correlation between the fluorescence intensities and the dose of Mal3-chlorin or the number of cells. AsPC1/luc cells were seeded into 96-well culture plates at a concentration of 1 Ã- 103 - 8 Ã- 103 cells/well and incubated overnight. Cells were subsequently incubated for 4 h with Mal3-chlorin (0.05-2 μM) and then fluorescence levels were measured using a Spectrafluor Plus (excitation; 405 nm, emission; 660 nm). Values are means {plus minus} SD, n = 6 in each.</p>
