Skip to main content

Long-term survival after palliative argon plasma coagulation for intraductal papillary mucinous neoplasm of the bile duct

A Correction to this article was published on 19 September 2020

This article has been updated


Intraductal papillary mucinous neoplasm of the bile duct (IPNB) is an epithelial tumor that can cause obstructive jaundice and cholangitis due to mucin production. Although the effectiveness of argon plasma coagulation in IPNB treatment has been demonstrated, the long-term effect of the therapy is largely unknown. Here, we have presented a patient with IPNB who underwent argon plasma coagulation with a follow-up period of more than 2 years. A 74-year-old woman was referred to our department for treatment of obstructive jaundice. Endoscopic retrograde cholangiopancreatography revealed marked dilation of intrahepatic and extrahepatic bile ducts and thick mucin drainage from the ampulla of Vater. IPNB was diagnosed pathologically from biopsy specimens. Surgery was not recommended because of the extensive intrahepatic spread of the lesion. Endoscopic sphincterotomy, endoscopic papillary large balloon dilation, and insertion of a metallic stent could not resolve the obstructive jaundice. Finally, argon plasma coagulation with percutaneous cholangioscopy was performed 3 times over 1 month. After treatment, obstructive jaundice was resolved and the patient’s clinical condition has been stable for more than 2 years, except for a single episode of transient cholangitis. In conclusion, argon plasma coagulation may be an alternative to surgery for the palliation of jaundice with IPNB.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

Change history



Intraductal papillary mucinous neoplasm of the bile duct


Argon plasma coagulation


Radiofrequency ablation


  1. Zen Y, Fujii T, Itatsu K, et al. Biliary papillary tumors share pathological features with intraductal papillary mucinous neoplasm of the pancreas. Hepatology. 2006;44:1333–43.

    CAS  Article  Google Scholar 

  2. Albores-Saavedra J, Adsay NV, Crawford JM, et al. Carcinoma of the gallbladder and extrahepatic bile ducts. WHO Classification of Tumours of the Digestive System; World Health Organization of Tumours. 4. Lyon: IARC; 2010. pp 266–73.

  3. Nakamura Y, Curabo MP, Franceshi S, et al. Intrahepatic cholangiocarcinoma. WHO Classification of Tumors of the digestive Systems; World Health Organization of Tumors. 4. Lyon: IARC; 2010. pp 217–24.

  4. Nakamura Y. A novel approach to biliary tract pathology based on similarities to pancreatic counterparts: is the biliary tract an incomplete pancreas? Pathol Int. 2010;60:419–29.

    Article  Google Scholar 

  5. Brauer BC, Norio F, Yang KC, et al. Direct cholangioscopy with narrow-band imaging, chromoendoscopy, and argon plasma coagulation of intraductal papillary mucinous neoplasm of the bile duct (with videos). Gastrointest Endosc. 2008;67:574–6.

    Article  Google Scholar 

  6. Boram C, Jin-Seok P, Seok J, et al. Direct cholangioscopy with argon plasma coagulation of an intraductal papillary mucinous neoplasm of bile duct. Korean J intern Med. 2019;34:940–1.

    Article  Google Scholar 

  7. Hamada T, Tsujino T, Sasahira N, et al. Percutaneous transhepatic cholangioscopy with an ultraslim video upper endoscope with CO(2) insufflation: a feasibility study. Gastrointest Endosc. 2011;74:696–9.

    Article  Google Scholar 

  8. Ohtsuka M, Kimura F, Shimizu H, et al. Intraductal papillary neoplasms of the bile duct. Int J Hepatol. 2014;2014:e459091.

    Article  Google Scholar 

  9. Gordon-Weeks AN, Jones K, Harriss E, et al. Systematic review and meta-analysis of current experience in treating IPNB: clinical and pathological correlates. Ann Surg. 2016;263:656–63.

    Article  Google Scholar 

  10. Luvira V, Pugkhem A, Bhudhisawasdi V, et al. Long-term outcome of surgical resection for intraductal papillary neoplasm of the bile duct. J Gastroenterol Hepatol. 2017;32:527–33.

    Article  Google Scholar 

  11. Fujikura K, Fukumoto T, Ajiki T, et al. Comparative clinicopathological study of biliary intraductal papillary neoplasms and papillary cholangiocarcinomas. Histopathology. 2016;69:950–61.

    Article  Google Scholar 

  12. Natov NS, Horton LC, Hegde SR. Successful endoscopic treatment of an intraductal papillary neoplasm of the bile duct. World J Gastrointest Endosc. 2017;9:238–42.

    Article  Google Scholar 

  13. Hollenbach M, Jürgen F, Joachim M, et al. Transhepatic intraductal radiofrequency ablation of biliary papillary mucinous neoplasm. Endoscopy. 2019;51:897–8.

    Article  Google Scholar 

  14. Mori A, Ohashi N, Nozaki M, et al. Feasibility of duodenal balloon-assisted direct cholangioscopy with an ultrathin upper endoscope. Endoscopy. 2012;44:1037–44.

    CAS  Article  Google Scholar 

  15. Shah RJ, Smolkin M, Yen R, et al. A multicenter, U.S. experience of single-balloon, double-balloon, and rotational overtures-assisted enteroscopy ERCP in patients with surgically altered pancreaticobiliary anatomy (with video). Gastrointest Endosc. 2013;77:593–600.

    Article  Google Scholar 

  16. Waxman I, Dillon T, Chmura K, et al. Feasibility of a novel system for intraductal balloon-anchored direct peroral cholangioscopy and endotherapy with an ultraslim endoscope (with videos). Gastrointest Endosc. 2010;72:1052–6.

    Article  Google Scholar 

  17. Oh HC, Lee SK, Lee TY, et al. Analysis of percutaneous transhepatic cholangioscopy-related complications and the risk factors for those complications. Endoscopy. 2007;39:731.

    Article  Google Scholar 

  18. Johanns W, Luis W, Janssen J, et al. Argon plasma coagulation (APC) in gastroenterology: experimental and clinical experiences. Eur J Gastroenterol Hepatol. 1997;9:581–7.

    CAS  Article  Google Scholar 

Download references


We would like to thank Editage ( for English language editing.


This research received no specific grants from any funding agency in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations



Drafting of the paper: JA; critical revision of the manuscript: NT; revision of the manuscript: JK; and technical support: KK, CS, SK, KT, KK, MO, MS, and KT.

Corresponding author

Correspondence to Nobuo Toda.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Human/animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this article, formal consent was not required. However, we received informed consent about APC therapy from the patients after explaining the potential complications. The Ethics Committee of Mitsui Memorial Hospital approved this therapy, which conformed to the provisions of the Declaration of Helsinki (as revised in Fortaleza, Brazil, October 2013).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Arai, J., Kato, J., Toda, N. et al. Long-term survival after palliative argon plasma coagulation for intraductal papillary mucinous neoplasm of the bile duct. Clin J Gastroenterol 14, 314–318 (2021).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Intraductal papillary mucinous neoplasm of the bile duct
  • Cholangioscopy
  • Argon plasma coagulation