A diagnosis of an intraluminal carcinoid tumor of the bile duct by using cholangioscopy

 CommentaryPrimary carcinoid tumor of the bile duct is a rare occurrence with about 2 dozen cases reported in the medical literature. Intraductal carcinoid presents as either a polypoid filling defect or an infiltrating stenotic lesion. The nature of the lesion typically is determined at surgery, but in this case, it was established at cholangioscopy. As with many endoscopic techniques, the evolution of cholangioscopy was labored and made with staccato-like advances, each built on the one that preceded it. In 1932, Antonucci used, intraoperatively, the first instrument specifically designed to look into the bile ducts. The intraoperative approach gave way to percutaneous cholangioscopy, which in turn yielded to peroral cholangioscopy and, until recently, cholangioscopy, when performed per-orally, used a mother-daughter endoscope operated by 2 endoscopists—one to manipulate the duodenoscope and a second to steer the cholangioscope and operate its working channel. The current SpyGlass System for cholangioscopy was developed by Y.K. Chen in 2007 and is a single-operator system that allows not only optical viewing, but also optically guided biopsies and electrohydraulic lithotripsy. Cholangiographic clarity is not yet perfect because there are only 6000 pixels in the SpyGlass System compared with 400,000 to 800,000 in a standard-definition colonoscope and 800,000 to 1.2 million pixels in a high-definition colonoscope. Technology has brought us to the lesion, has enabled us to see it, albeit not perfectly, and also has allowed sampling. Carl Sagan said “Somewhere, something incredible is waiting to be known.” His point of reference, I believe, was with a vision that extended into space, while my universe of interest is much closer to home—the GI and biliary tracts, for example. But look how far we have come in such a short time; we really have just begun our very exciting journey.Lawrence J. Brandt, MDAssociate Editor for Focal Points

PII: S0016-5107(09)02577-2

doi:10.1016/j.gie.2009.10.014

© 2010 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.