Mapping biopsy for bile duct cancer using a novel device delivery system

Abstract

A 56-year-old man presented to our department with abnormal liver function tests. Imaging studies showed a distal biliary stricture with dilated intrahepatic bile ducts ([Fig. 1]). An endoscopic ultrasound (EUS) revealed that there was continuous mild thickening of the wall of the upstream bile duct ([Fig. 2 a, b]). Cholangiocarcinoma was suspected; therefore, an endoscopic retrograde cholangiography (ERC) and an intraductal ultrasound were performed, which showed circumferential thickening of the biliary wall ([Fig. 2 c, d]). Mapping biopsies up to the hilar bile duct and targeted biopsies of the biliary stricture were taken using a novel device delivery system (EndoSheather; Piolax, Japan) ([Fig. 3]; [Video 1]). As cancer cells were observed in both mapping and targeted biopsy samples ([Fig. 4 a]), additional mapping biopsies were performed on the right and left hepatic ducts ([Fig. 5]), but no malignant cells were detected ([Fig. 4 b]). Based on these imaging and pathological findings, a left hepatopancreatoduodenectomy was performed, and a negative surgical margin was confirmed.