A 39-year-old woman was admitted to our hospital with pain in the right upper quadrant
for more than 2 months. Magnetic resource imaging (MRI) showed that the patient had
liver calcification, dilatation of the intrahepatic bile duct and upper part of the
extrahepatic bile duct, and hepatic parenchymal nodules ([Fig. 1]). The patient had undergone cholecystectomy for gallstones a year previously. For
further diagnosis and treatment, we decided to perform biliary exploration.
Fig. 1 Magnetic resonance image showing dilatation of the bile ducts and hepatic parenchymal
nodules.
During the procedure, there were no obvious stones seen but many papillary neoplasms
with silt-like mucus were seen in the hilar and intrahepatic bile ducts on choledochoscopy
([Fig. 2]), which were thought to be biliary papillomatosis [1]. A biopsy was taken, which confirmed the diagnosis ([Fig. 3]). Biliary papillomatosis is a rare and fatal disease characterized by multiple papillary
tumors of variable distribution and extent in the intrahepatic and/or extrahepatic
biliary tree [2]
[3]. In an effort to destroy the tumors, 6 weeks later, we performed cholangioscopic
electrocoagulation through a T-tube tract ([Video 1]). With there being little bleeding during the endoscopic operation, we re-inserted
a T-tube into the common bile duct, and the patient returned to the ward safely.
Fig. 2 Choledochoscopy view showing papillary neoplasms in the intrahepatic bile duct.
Fig. 3 Histology of the biopsy specimen showing biliary papillomatosis.
Video 1 Choledochoscopy showing many papillary neoplasms in the hilar and intrahepatic bile
ducts. Cholangioscopic electrocoagulation is performed in an effort to destroy the
tumors. Follow-up choledochoscopy shows the procedure was a success.
Planned follow-up of the patient by choledochoscopy 3 weeks later showed that the
visible bile duct silt-like mucus had disappeared, the hilar and intrahepatic bile
ducts were smooth with some scarring visible, but there was no evidence of bile duct
papilloma ([Fig. 4]). The patient was discharged from the hospital after a period of time.
Fig. 4 Choledochoscopy view showing that the hilar and intrahepatic bile ducts were smooth
although with some scarring.
Endoscopy_UCTN_Code_TTT_1AR_2AF
Endoscopy E-Videos is a free 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.
This section has its own submission website at https://mc.manuscriptcentral.com/e-videos
