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DOI: 10.1055/a-2499-7279
The usefulness of cholangioscopy in the diagnosis of peribiliary cysts: a case report
A 63-year-old woman with no medical or surgical history came to the outpatient clinic presenting with 6 months of unquantified unintentional weight loss and jaundice. Physical examination documented only jaundice with no other alterations.
Laboratory results documented an obstructive biliary pattern ([Table 1]). Magnetic resonance imaging (MRI) showed no evidence of neoplasia and a dilatation of the choledochus and intraductal image ([Fig. 1]). Echo-endoscopy showed only an image suggestive of a 2-mm stone in the choledochus ([Fig. 2]). Endoscopic retrograde cholangiopancreatography and cholangioscopy was then performed using direct visualization by SpyGlass (Boston Scientific, Marlborough, Massachusetts, USA) in which multiple subepithelial, rounded and translucent lesions corresponding to cysts were observed, some of which ruptured spontaneously during the procedure ([Fig. 3], [Video 1]). Jaundice resolved after the procedure. Biopsies of the lesions were taken by SpyBite (Boston Scientific) without finding neoplastic pathology. After 6 months of observation, the patient is asymptomatic and continues to be followed up.






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Peribiliary cysts [1] are saccular structures formed from the dilatation of peribiliary glands. They are usually tiny (<10 mm) and do not communicate with the bile ducts [2]. They are mainly associated with cirrhosis and enolism (38%). They are more prevalent in the male sex (80%), with less female representation. Regarding clinical manifestations, obstructive and constitutional biliary syndrome with consequent suspicion of neoplastic obstruction of the biliary tract is the reason for consultation and clinical approach in 19% of patients [3] . With respect to detection, although computed tomography (CT) and MRI can document typical cystic lesions and thus be diagnostic in up to 48% and 64% of cases, respectively, in some scenarios cholangioscopy may be required to characterize and biopsy in order to clarify the diagnosis [4] . Regarding treatment, the authors agree that asymptomatic patients do not require specific management or follow-up. In our case, cholangioscopy was indicated due to obstructive biliary involvement, with subsequent resolution of symptoms.
Endoscopy_UCTN_Code_TTT_1AQ_2AK
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Conflict of Interest
The authors declare that they have no conflict of interest.
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References
- 1 Nakanuma Y, Kurumaya H, Ohta G. Multiple cysts in the hepatic hilum and their pathogenesis. A suggestion of periductal gland origin. Virchows Arch 1984; 404: 341-350
- 2 Drenth J. et al. EASL Clinical Practice Guidelines on the management of cystic liver diseases. J Hepatol 2022; 77: 1083-1108
- 3 Bazerbachi F, Haffar S, Sugihara T. et al. Peribiliary cysts: A systematic review and proposal of a classification framework. BMJ Open Gastroenterol 2018; 5: e000204
- 4 Narayan RR, Juakiem WY, Poultsides GA. et al. Peribiliary cysts masquerading as choledocholithiasis. VideoGIE 2023; 8: 351-353
Correspondence
Publication History
Article published online:
21 January 2025
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
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References
- 1 Nakanuma Y, Kurumaya H, Ohta G. Multiple cysts in the hepatic hilum and their pathogenesis. A suggestion of periductal gland origin. Virchows Arch 1984; 404: 341-350
- 2 Drenth J. et al. EASL Clinical Practice Guidelines on the management of cystic liver diseases. J Hepatol 2022; 77: 1083-1108
- 3 Bazerbachi F, Haffar S, Sugihara T. et al. Peribiliary cysts: A systematic review and proposal of a classification framework. BMJ Open Gastroenterol 2018; 5: e000204
- 4 Narayan RR, Juakiem WY, Poultsides GA. et al. Peribiliary cysts masquerading as choledocholithiasis. VideoGIE 2023; 8: 351-353





