Project description:We encountered a case of wall thickening of the bile duct in a 69-year-old man. endoscopic retrograde cholangiopancreatography (ERCP) was performed for detailed examination. When an area considered to be the healthy bile duct was examined by peroral cholangioscopes (POCS) (SPYGlass DS), the vascular network was observed. POCS-guided, probe-based confocal laser endomicroscopy (pCLE; CholangioFlex, Cellvizio; Mauna Kea Technologies, Paris, France), performed using the fluorescein-dripping method on this area, showed a reticular network of thin dark branching bands, which were presumed to be a collagen bundle or lymphatic vessels according to the Miami Classification. However, 8 μm-diameter objects thought to be red blood cells were observed inside the bands, which were considered to correspond to the vascular network observed on POCS. A biopsy specimen of this site was taken. The histological examination demonstrated capillaries just beneath the bile duct epithelium. Thus, the histology also suggested the presence of the vascular network. In this study, we obtained findings that cannot be explained in terms of the Miami Classification, which we describe here with a video.

| S-EPMC7273719 | biostudies-literature

Utility of Direct Peroral Cholangioscopy Using a Multibending Ultraslim Endoscope for Difficult Common Bile Duct Stones.

Project description:Background/aimsTreatment options for difficult bile duct stones are limited. Direct peroral cholangioscopy (POC)-guided lithotripsy may be an option. A newly developed multibending (MB) ultraslim endoscope has several structural features optimized for direct POC. We evaluated the utility of direct POC using an MB ultraslim endoscope for lithotripsy in patients with difficult bile duct stones.MethodsTwenty patients with difficult bile duct stones, in whom stone removal using conventional endoscopic methods, including mechanical lithotripsy, had failed were enrolled from March 2018 to August 2019. Direct POC-guided lithotripsy was performed by electrohydraulic lithotripsy or laser lithotripsy. The primary outcome was complete ductal clearance, defined as the retrieval of all bile duct stones after lithotripsy confirmed by balloon-occluded cholangiography and/or direct POC.ResultsThe technical success rate of direct POC was 100% (20/20), and the free-hand insertion rate was 95% (19/20). Direct POC-guided lithotripsy, attempted by electrohydraulic lithotripsy in nine patients (45%) and laser lithotripsy in 11 patients (55%), was successful in 95% (19/20) of the patients. Complete ductal clearance after direct POC-guided lithotripsy was achieved in 95% (19/20) of patients. Patients required a median of 2 (range, 1-3) endoscopic retrograde cholangiopancreatography sessions for complete stone removal. Adverse event was observed in one patient (5%) with hemobilia and was treated conservatively.ConclusionsDirect POC using an MB ultraslim endoscope was safe and effective for lithotripsy in patients with difficult bile duct stones.

| S-EPMC9289834 | biostudies-literature

A rare case of hepatocellular carcinoma with bile duct invasion diagnosed by peroral cholangioscopy.

Project description:Video 1Peroral cholangioscopy showed a 20-mm-diameter, stalked, floating, round mass in the hilar region. The surface of the tumor was covered with white fur, and the tumor tissue was partially exposed in a map-like pattern. The mass was penetrable even with a guidewire, and it bled easily. Biopsies were performed using biopsy forceps, and the tumor bled easily even with biopsy.

| S-EPMC8350986 | biostudies-literature

Identification of bleeding points after bile duct biopsy using red dichromatic imaging during peroral cholangioscopy: A case report.

Project description:Red dichromatic imaging is a new image-enhancement technology that clarifies the differences in blood concentrations and improves the visibility of the bleeding point. A 71-year-old man was presented with a common bile duct stone, which was completely removed using electrohydraulic shock wave lithotripsy with peroral cholangioscopy. During peroral cholangioscopy, a nodular lesion was found at the confluence of the cystic duct, and a forceps biopsy was performed. It was difficult to confirm the bleeding point using white-light imaging because of the pooling of blood. After switching to red dichromatic imaging mode 2 and washing the bile duct with saline solution, the bleeding point was observed in darker yellow than the surrounding blood, allowing the identification of the bleeding point. Red dichromatic imaging can be used in the future to maintain hemostasis during peroral cholangioscopy.

| S-EPMC9947457 | biostudies-literature

Common bile duct intussusception during ERCP for stone removal.

Project description: Not available

| S-EPMC5965731 | biostudies-literature

Cholangioscopy-guided electrohydraulic lithotripsy of a large bile duct stone through a percutaneous T-tube tract.

Project description: Not available

| S-EPMC6251702 | biostudies-literature

Removal of a migrated biliary stent buried in a common bile duct stone using electrohydraulic lithotripsy

Project description: Not available

| S-EPMC11317631 | biostudies-literature