PMC5992338_01
Computed tomography showing dilated extrahepatic and intrahepatic biliary system.
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F1
Endoscopic retrograde cholangiopancreatography (ERCP) with a biliary stent was planned due to evidence of intra- and extrahepatic biliary dilation and profound jaundice with total bilirubin 10.0 mg/dL (Figure 1).
Massive tumor infiltration into the common bile duct and major papilla, causing partial obstruction of the duodenal lumen.
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F2
During ERCP, massive tumor infiltration into the common bile duct (CBD) and major papilla caused partial obstruction of the duodenal lumen and prevented major papilla cannulation (Figure 2).
Deployment of a 15 x 10 mm lumen-apposing stent.
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F3
The catheter sheath was retracted, and the first flange (proximal) of the lumen-apposing stent was deployed (Figure 3).
Bile leakage outside the fistula was ruled out by contrast injection.
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F4
Bile leakage outside the fistula was ruled out with contrast injection (Figure 4).