Endosc Int Open 2014; 02(02): E124-E125
DOI: 10.1055/s-0034-1377174
Case series
© Georg Thieme Verlag KG Stuttgart · New York

Intraductal biliary polypectomy performed with a nasogastroscope

Anne Druez
1   CHU Dinant Godinne UCL Namur – Gastroenterology, 1, avenue Dr. G. Thérasse, 5530 Yvoir, Belgium
,
Elizaveta Kim
2   Cliniques Universitaires St-Luc – Hepato-Gastroenterology, Brussels, Belgium
,
Christine Sempoux
3   Cliniques Universitaires St-Luc – Pathology, Brussels, Belgium
,
Pierre Deprez
2   Cliniques Universitaires St-Luc – Hepato-Gastroenterology, Brussels, Belgium
› Institutsangaben
Weitere Informationen

Corresponding author

Anne Druez
CHU Dinant Godinne UCL Namur – Gastroenterology
1, avenue Dr. G. Thérasse 5530 Yvoir
Belgium   
Fax: 003281423267   

Publikationsverlauf

submitted 03. April 2014

accepted 22. April 2014

Publikationsdatum:
06. Juni 2014 (online)

 

Introduction

A 79-year-old man was admitted to emergency for septic shock due to angiocholitis, with acute renal failure, hyperlactatemia, and thrombopenia. His medical history included a cholecystectomy for acute cholecystitis and removal of choledocholithiasis that occurred more than 10 years ago.


#

Case report

Computed tomography confirmed the recurrence of cholelithiasis in the common bile duct (CBD) and in the dilated right hepatic duct associated with atrophy of S6 – 7 hepatic segments ([Fig. 1]). Multiple stones and pus were extracted from the CBD during endoscopic retrograde cholangiopancreatography, which revealed a tight stricture, which could not be bypassed using several guide wires and upstream dilation, and intraductal stones in the right hepatic duct. The duodenoscope was therefore replaced by a nasogastroscope (GIF-N180, Olympus) introduced with a 50 cm overtube for stability, to allow visualization of the site of stenosis and removal of the stone in the right hepatic duct ([Fig. 2]). A 6 mm polyp (Paris 0 – 1 sp) ([Fig. 3]) was visualized below the stricture and was removed using a diathermy snare (SD-221L-25, Olympus) ([Fig. 4]). This was followed by several targeted biopsies of the biliary stricture. Scopes were exchanged over a 0.035 Jagwire to dilate the stricture using a 6 mm × 4 cm Hurricane balloon, to extract pus and stones, and to place a 7-Fr plastic biliary stent. Histology showed no malignant cells, but revealed an inflammatory infiltrate in the biopsies and a fibroinflammatory polyp. During follow-up that lasted almost two years, the patient’s progress was favorable, the stent was left in place for more than one year, and he experienced no recurrent cholangitis.

Zoom Image
Fig. 1 Abdominal computed tomography scan showing the dilated right intrahepatic ducts with intraductal stones.
Zoom Image
Fig. 2 Fluoroscopy showing the position of the nasogastroscope and the biopsy forceps in the right hepatic duct.
Zoom Image
Fig. 3 Cholangioscopic view of the polyp below the duct stricture.
Zoom Image
Fig. 4 Cholangioscopic view of the post-polypectomy site.

#

Discussion

This case report illustrates the feasibility of biliary intraductal polypectomy during cholangioscopy performed with a nasogastroscope.


#

Abbreviations

CBD: common bile duct


#

Competing interests: None

Corresponding author

Anne Druez
CHU Dinant Godinne UCL Namur – Gastroenterology
1, avenue Dr. G. Thérasse 5530 Yvoir
Belgium   
Fax: 003281423267   

Zoom Image
Fig. 1 Abdominal computed tomography scan showing the dilated right intrahepatic ducts with intraductal stones.
Zoom Image
Fig. 2 Fluoroscopy showing the position of the nasogastroscope and the biopsy forceps in the right hepatic duct.
Zoom Image
Fig. 3 Cholangioscopic view of the polyp below the duct stricture.
Zoom Image
Fig. 4 Cholangioscopic view of the post-polypectomy site.