A 68-year-old woman had a solitary 12.0 cm hepatic cyst with a septum. The cyst was located near the hepatic hilum and she presented with obstructive jaundice caused by compression of the hilar bile duct. Stenosis of the common hepatic duct was detected at the porta hepatis on endoscopic retrograde cholangiography (ERC), and encasement of the right hepatic artery at the same level was revealed ...

ing cholangioscopy using the reusable 0.77-mm SpyGlass fiberoptic probe (Boston Scientific, Massachusetts, USA) with two double-lumen endoscopic retrograde cholangiopancreatography (ERCP) cannulae. The TandemXL cannula (Boston Scientific) is a 7-Fr double-lumen catheter with a 5.5-Fr tip (●" Fig. 1a), and the Swing-tip cannula (Olympus, Tokyo, Japan) is a 9-Fr single-lumen catheter with a 4.5-F...

Endoscopic transpapillary biopsy has been widely performed for the diagnosis of biliary disease. Direct-vision biliary biopsy using peroral cholangioscopy has been reported to be very useful [1–4]. At centers where peroral cholangioscopy is unavailable, biliary biopsy can be performed under fluoroscopic guidance. It is however sometimes difficult to obtain adequate biopsy specimens owing to iss...

A 46-year-old man with segment 8 hepatocellular carcinoma (HCC) from hepatitis C-related, Child–Pugh class A cirrhosis underwent successful hepatic resection. This was complicated by a postoperative bilioma that was treated by percutaneous drainage. He presented again 6 months later with abdominal pain and cholestasis. Computed tomography (CT) of the liver showed no tumor recurrence. Magnetic r...

Direct biliary drainage using ultraslim endoscopes has been developed for treating acute cholangitis. We present a case wherein direct biliary drainage with ultraslim endoscopy was successfully used in the setting of an occluded a partially covered self-expandable metallic stent (PC-SEMS) in a patient with unresectable cystic duct carcinoma and duodenal stenosis. A 72-year-old man presented wit...

A 29-year-old woman presented with right-sided abdominal pain and jaundice. The patient was postpartum but otherwise healthy. Her total bilirubin level was 74μmol/L. Abdominal ultrasound revealed a 9-mm dilated proximal common bile duct (CBD), a suspected CBD stone and a distended gallbladder with gallstones. The patient underwent endoscopic retrograde cholangiopancreatography (ERCP); however, ...

ly rare anomaly of the biliary tract system, which was first described by Vesalius in 1543 [1]. Recent advances in radiologic examinations have facilitated the correct diagnosis and management of this condition, but visualization of the anomaly using cholangioscopy has not been reported [2]. We report the finding of a double common bile duct with ectopic drainage into the duodenal bulb, which w...

who presented with obstructive jaundice due to a large (2.5 cm) stone in the common bile duct (CBD). We attempted mechanical lithotripsy but the stone was too big for the basket (●" Fig. 1). We decided to break the stone with electrohydraulic lithotripsy (EHL) and carry out direct peroral cholangioscopy instead of motherbaby endoscopy. In our experience, the mother-baby endoscopic system has se...

been recognized as a useful technique for the removal of choledocholithiasis, which is usually performed under the control of a peroral “mother−baby” cholangioscopic system or percutaneous transhepatic choledochoscopy [1,2]. However, the method may be disadvantageous due to its complicated procedure. Recently, the use of an ultraslim endoscope to direct cholangioscopy [3] as well as endoscopic ...