Cholangioscopy in diagnosis of radiation-induced bile duct stricture after radiotherapy for Hodgkin’s lymphoma

This clinical observation describes a rare case of delayed radiation-induced bile duct stricture after radiotherapy for Hodgkin’s lymphoma. The description of the endoscopic picture of post-radiation bile duct stricture is published for the first time. A 34 year old patient was referred to the P.A. Herzen Moscow Research Institute of Oncology with suspected pancreatic/extrahepatic bile ducts cancer for diagnosis and treatment. Biopsy was performed twice at a local hospital. The results of the morphological study do not allow making categorical conclusions. Cholangioscopy was performed at the Herzen Institute. Detected stenosis of the confluence and common bile duct over a length of 20 mm. Circular and longitudinal white scars, flat raised red areas (like a “geographical map”), as well as pseudopapillary areas and shapeless white deposits were on the walls of the bile ducts in the problem site. The vascular pattern is not differentiated, contact bleeding of moderate intensity. The lumen of the right lobar duct is preserved, the biliary mucosa is white with single circular scars, the vascular pattern is blurred. A biopsy was performed. The conclusion of the pathomorphological study - pronounced proliferation of glandular epithelium. The oncology council concluded that the patient had post-radiation stricture of the bile ducts, based on the anamnesis data (specific treatment of Hodgkin’s lymphoma with nodular sclerosis stage IV), radiation examination methods, endoscopic picture, pathomorphological conclusion. Endoscopic treatment - multi-stage endoscopic stenting - was recommended.