Endoscopy 2022; 54(08): E405-E406
DOI: 10.1055/a-1541-7246
E-Videos

Resection of a tubular adenoma in the distal common bile duct through percutaneous choledochoscopy

Long He*
Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
,
Shuai Bai*
Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
,
Liansong Ye
Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
,
Bing Hu
Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
› Author Affiliations
Supported by: 1·3·5 project for disciplines of excellence – Clinical Research Incubation Project, West China Hospital, Sichuan University 20HXFH016

A 59-year-old man was admitted to our hospital with a neoplasm in the distal common bile duct ([Fig. 1]), which had been detected during laparoscopic exploration for biliary stone in a local hospital 2 months earlier. Magnetic resonance cholangiopancreatography showed a filling defect without invasion of surrounding organs ([Fig. 2]). Combining the result of multidisciplinary discussion and the wishes of the patient, percutaneous choledochoscopic treatment through the T-tube tract was performed for him ([Video 1]).

Zoom Image
Fig. 1 Accidentally detected neoplasm in the common bile duct of a 59-year-old man.
Zoom Image
Fig. 2 Magnetic resonance cholangiopancreatography showed a filling defect in the common bile duct without invasion of surrounding organs.

Video 1 The pedicled lesion was reached using percutaneous choledochoscopy through the sinus tract formed by the T-tube. A hot snare was used to resect the lesion under direct visualization. At the end, a clean and flat wound bed was left after the resection.


Quality:

After identification of the pedunculated neoplasm ([Fig. 3 a]), a hot snare was used to resect the lesion under direct visualization ([Fig. 3 b]). Then, a stone basket was used to extract the lesion ([Fig. 3 c]). The wound was clean and flat, without residual tumor ([Fig. 3 d]). The whole process took about 10 minutes and there was no complication. Pathologic analysis showed the neoplasm to be a tubular adenoma ([Fig. 4]).

Zoom Image
Fig. 3 a–d The process of resection. a The pedunculated neoplasm. b A hot snare was used to resect the lesion under direct visualization. c The resected specimen. d A clean and flat wound bed left after the resection.
Zoom Image
Fig. 4 H&E staining indicated the lesion was tubular adenoma.

With unknown malignant potential and the risk of causing obstructive jaundice, benign adenomas of the common bile duct are suggested to be treated by surgery at present time. However, the surgical procedure is extensive and complex. In recent years, peroral cholangioscopic procedures have been reported for treating benign neoplasms in the biliary tract, ensuring the minimum of injury and a good outcome [1]. As far as we know, the present case is the first report regarding percutaneous choledochoscopy for resection of a benign biliary neoplasm. Our experience indicates that percutaneous choledochoscopy could be an alternative for treatment of benign biliary tumors. Given the risk of recurrence of adenomas, regular follow-up is critical. The safety and effectiveness of this endoscopic method requires confirmation by further studies.

Endoscopy_UCTN_Code_TTT_1AR_2AJ

Endoscopy E-Videos
https://eref.thieme.de/e-videos

Endoscopy E-Videos is an open access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high quality video and all contributions are freely accessible online. Processing charges apply (currently EUR 375), discounts and wavers acc. to HINARI are available.

This section has its own submission website at https://mc.manuscriptcentral.com/e-videos

* Co-first authors




Publication History

Article published online:
08 September 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • Reference

  • 1 Bendezu-Garcia RA, Andujar-Murcia X, Loras C. Endoscopic removal of tubulovillous adenoma with high grade focal dysplasia in the distal common bile duct. Endoscopy 2019; 51: E319-E320