An 80 year old patient was referred for acute cholangitis. A 2 × 1,5 cm lesion suspect
of a distal bile duct stone was detected in US and ERCP. However, the lesion was fixed
to the bile duct wall. EUS and biopsy revealed a distal biliary adenoma. The patient
refused surgery but agreed to an experimental approach. A percutaneous stabile fistula
tract was created and dilated over 2 weeks until 20". A sterilized therapeutic bronchoscope
was used and the tumor located at the level of the distal common bile duct. Successful
keedle knife excision and transpapillary expulsion of the tumor was achieved after
prior EPT. A percutaneous transhepatic drainage was temporarily placed. There was
fortunately no acute bleeding or perforation but the tumor specimen was lost to the
small intestine. The patient recovered completely but died three years later due to
a local recurrence.
