In endoscopic laser radiation for treating malignant biliary stenosis, the endoscopist often encounters difficulty due to a lack of visual field. To solve this probrem, the YAG laser lateral radiation tip, capable of safe radiation even under gaidance of X-ray imaging, was clinically applied to treatment of cholangiocarcinoma.
The subject was a 60-year-old female who underwent chorecystectomy and side-to-side choledochoduodenostomy 20 years ago. In March, 1993, abdominal echography revealed a tumor mass about 10cm in diameter, centering in the posterior segment of the right hepatic lobe, the biopsic diagnosis being papillary adenocarcinoma. ERCP detected an anomalous arrangement of pancreatico-biliary ducts. We persuated the patient's family and patient to make the patient undergo surgery, but failed to obtain consent; the patient was followed up as an outpatient. In April, 1994, the patient developed jajundice, and was re-admitted to our hospital. PTCD was performed on the dilated left and right hepatic ducts. Afer the PTCD fistulae were dilated, both hepatic ductal stenosis were radiated with YAG laser, using a lateral radiation tip, under guidance of X-ray imaging. The radiation output was 15-20 watt; the tip was gone and returned little by little in the stenoses several times. Later, the radiation effect was confirmed by fistulography and cholangioscopy; underradiated portions were further radiated using an ordinary tip. After laser treatment, the billiary stenoses improved markedly; the patient was discharged from the hospital, with a Wall stentbeing expandable metallic stent in the left and right bile duct.
Katsu et al. developed a laser tip capable of rectangular refraction and hence lateral radiation of a laser beam, and applied it to treatment of malignant esophageal stenosis. Inthe present study, the lateral radiation tip was clinically applied it to treatment of malignant biliary stenosis, which were difficult to radiate due to lack of visual field and was found to permit easy radiation even under gaidance of X-ray imaging, a clinically useful aspect.