ASSESSMENT OF EXTRAHEPATIC COMMON BILE DUCT BILIARY INTRAEPITHELIAL NEOPLASIA (BILIN) BY SINGLE-OPERATOR CHOLANGIOSCOPY (SOC)

Introduction:

Biliary intraepithelial neoplasia (BilIN), a premalignant lesion and precursor of bile duct adenocarcinoma, rarely occurs in the extrahepatic bile ducts. There are no uniform guidelines on its management.

Clinical case:

We report a case of BilIN in the common bile duct (CBD) in a 64-year-old man, who presented with upper abdominal malaise without jaundice. Imaging modalities revealed an indeterminate stricture in the CBD with upstream biliary dilatation. Single-operator cholangioscopy (SOC) showed a small proliferative CBD lesion with endoscopic features suspicious for malignancy. Biopsies, however, were indefinite for dysplasia. The patient underwent laparotomy with resection of an extrapancreatic segment of the CBD and hepatic-jejunostomy Pathological examination gave a definite diagnosis of low-grade BilIN in the CBD. No evidence of recurrence was observed during a 1-year follow-up period.

Conclusion:

To the best of our knowledge, we report for the first time assessment of this kind of tumor involving exclusively the CBD by SOC and the usefullness of this procedure in guiding further management.