PERCUTANEOUS TRANSHEPATIC CHOLANGIOSCOPIC RESECTION OF AN DISTAL BILE DUCT ADENOMA IN ESD TECHNIQUE

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.