PMC10392209_01
Endoscopic view of papilla where extensive amount of mucus is plugging common bile duct, occluding plastic 10F pigtail stents.
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After repeated ERCPs with removal of substantial amount of mucus debris and repeated insertion of plastic 10F pigtail stents in each procedure, the severe septic cholangitis persisted (Figure 1).
PMC10392209_02
Images from SpyGlass DS cholangisopy (Boston Scientific, MA, USA) showing biliary IPMN tumour (intraductal papillary mucinous neoplasm) in the common bile duct with mucus-producing villous protrusions macroscopically resembling its more common counterpart in the main pancreatic duct (pancreatic main duct IPMN).
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SpyGlass DS control was performed in September 2020 (Figure 2). Similarly to earlier attempt, the RF instrument made no proper circular contact due to wide diameter of the CBD of up to 15 mm.
A fluoroscopy image after ERCP, SpyGlass DS cholangioscopy and eventual placement of fully covered oesophageal stent into the common bile duct to cover entire mucus-producing tumour (80 mm x 18-24 mm, Niti-S, Taewoong, Medical, Gyeonggi-Do, South-Korea).
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Medical, Gyeonggi-Do, South-Korea) of 80 mm length and 18-24 mm diameter was introduced into the CBD through the working channel of the standard Olympus duodenoscope (Olympus Europe, Hamburg, Germany) (Figure 3). The proper positioning of the stent was controlled with SpyGlass DS to exclude stent-related obstruction in liver hilum. Mucus-producing tumour region in the CBD was now entirely sealed with the silicon covered large diameter self-expanding stent.