title: Early bile duct cancer detected by direct peroral cholangioscopy with narrow-band imaging after bile duct stone removal.
abstract: Cholangioscopy not only enables the direct visualization of the biliary tree, but also allows for forceps biopsy to diagnosis early cholangiocarcinoma. Recently, some reports have suggested the clinical usefulness of direct peroral cholangioscopy (POC) using an ultra-slim endoscope with a standard endoscopic unit by a single operator. Enhanced endoscopy, such as narrow band imaging (NBI), can be helpful for detecting early neoplasia in the gastrointestinal tract and is easily applicable during direct POC. A 63-year-old woman with acute cholangitis had persistent bile duct dilation on the left hepatic duct after common bile duct stone removal and clinical improvement. We performed direct POC with NBI using an ultra-slim upper endoscope to examine the strictured segment. NBI examination showed an irregular surface and polypoid structure with tumor vessels. Target biopsy under direct endoscopic visualization was performed, and adenocarcinoma was documented. The patient underwent an extended left hepatectomy, and the resected specimen showed early bile duct cancer confined to the ductal mucosa.
authors.affiliation: Digestive Disease Center, Soonchunhyang University School of Medicine, Bucheon, Korea.
authors.forename: Hyung Ki
authors.initials: HK
authors.lastname: Kim
authors.forename: Jong Ho
authors.initials: JH
authors.lastname: Moon
authors.forename: Hyun Jong
authors.initials: HJ
authors.lastname: Choi
authors.forename: Hee Kyung
authors.initials: HK
authors.lastname: Kim
authors.forename: Seul Ki
authors.initials: SK
authors.lastname: Min
authors.forename: Jong Kyu
authors.initials: JK
authors.lastname: Park
authors.forename: Young Deok
authors.initials: YD
authors.lastname: Cho
authors.forename: Sang-Heum
authors.initials: SH
authors.lastname: Park
authors.forename: Moon Sung
authors.initials: MS
authors.lastname: Lee