UVA Health System physician has a new way to treat bild duct cancer.

Nurse sonographer and comprehensive liver fluke and bile duct cancer control in rural Thailand.
Worldwide bile duct cancer is rare BUT is most common in Thailand. Early cancer can be operable but it is asymptomatic and almost all patients came with late stage which are deadly and incurable.
It is caused mainly by liver fluke and people are infected through eating raw flesh water fishes which are favorite dishes in northeast Thailand including Phanomphrai District.
The only screening method for bile duct cancer is computerized tomography scan which is very expensive and can only be performed in large hospital with some radiation hazard, and nearly inaccessible for risk group. Providers and people were sharing pain and tears of despair.
For the first time in Thailand, Phanomphrai Hospital has introduced nurse-performed ultrasound study for bile duct cancer screening and integrated into comprehensive strategy plan to eliminate liver fluke and bile duct cancer. In collaboration with Chulabhorn and Roi Et Hospitals which are cancer specialized organizations, nurse sonographers have also been trained about quality assurance, supervision and expert consulting systems such as PACS and LINE application.
Aims to include those underprivileged people in rural and remote areas, it is innovative and affordable services to all to increase access and coverage of bile duct cancer screening especially in low-resource settings like Phanomphrai District.
Featuring nurse sonographer in bile duct cancer screenings, Phanomphrai Hospital provides bile duct cancer screenings free of charge with regular fiscal budget under the Universal Health Coverage Scheme. Coverage is increasing rapidly and Phanomphrai Hospital has been awarded by Ministry of Public Health and Khon Kaen University for highest risk registration and highest bile duct screenings.
With the goal of ‘leaving no one behind’ in mind, Phanomphrai Hospital works closely with village health volunteers to provide ultrasound services at district and sub-district levels. ‘Bring services to the people’ shall represent a principle of the program and helps reduce people’s out-of-pocket expense and increase access to quality and affordable services at community level which make the program more inclusive and equitable for all.
Phanomphrai Hospital has also been working with many organizations and successfully push liver fluke and bile duct cancer into the National Agenda which has been endorsed by the National Health Assembly Year 2014 and approved by the Cabinet since 2016.

Inspired and guided by His Majesty the Late King Bhumibol the Great’s Philosophy of Sufficiency Economy on moderation, reasonableness and self-immunity, Phanomphrai Hospital runs liver fluke and bile duct cancer prevention and control plan with both local and central organizations. Phanomphrai District Health Board accepted the plan as district agenda.
Up to now more than 15,000 people aged 40 years or more have been screened with more than 50 cases of liver and bile duct cancer found and more than 8 lives saved. Improving health literacy, environmental management and sewage treatment make liver fluke infection rate declined from 22% to 3%.
The Phanomphrai Organic Agriculture Network and others organizations have actively participated to save our planet with sustainable agriculture and farming through a foundation of trust, social networks and knowledge exchange. Phanomphrai Hospital also hosted World Soil Day 2018: Be the Solution to Soil Pollution event.
Health Inequalities and Social Determinants of Health have also been considered and seriously counted as Phanomphrai Hospital try to close the health gap. IF YOU’RE DOING NOTHING, DO SOMETHING. IF YOU’RE DOING A LITTLE, DO MORE. IF YOU’RE DOING A LOT, DO BETTER.
The Medical Sonography School is the first sonographer school in Thailand since 2016 with partly inspiration from the collaboration between Phanomphrai and Chulabhorn Hospitals. It is a component of The Chulabhorn Royal Academy with a mandate to produce qualified sonographers in response to increasing needs all over the country including bile duct cancer screening.
Phanomphrai Hospital and nurse sonographers strive for delivering more inclusive and equitable public services for all to help people fully enjoy flourishing and productive lives and pursue one’s life plans. Thank you and good bye.

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John Bridgewater, BA, MBBS, MRCP, PhD, University College London Hospitals NHS Foundation Trust, London, UK, gives his thoughts on the current treatment of advanced cholangiocarcinoma in the UK, and discusses a new treatment option - pemigatinib - which is now available in the UK. Patients with advanced cholangiocarcinoma have historically been able to only access limited treatment options including surgery and chemotherapy. This interview was recorded via an online conference call with The Video Journal of Oncology (VJOncology).

Observe the X-Suit NIR, Olympus’ self-expanding biliary stent engineered to keep the bile duct open and patent. It is designed using a combination of wide and narrow strut rings which respectively contribute to the stent's strength and flexibility. Due to the unique strut geometry, X-Suit NIR undergoes little to no foreshortening after placement. Radiopaque markers in the proximal and distal ends allow the physician to confirm placement under fluoroscopy.
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