Peroral cholangioscopy: Update on the state-of-the-art

Figure 3 Example of an indeterminate biliary stricture further evaluated by cholangioscopy, initially thought to be Mirizzi syndrome secondary to chronic choledocholithiasis. A: Magnetic resonance cholangiopancreatography (T2 HASTE, coronal projection) demonstrating cholelithiasis, choledocholithiasis, and right hepatic ductal dilation as well as possible common hepatic duct (CHD) obstruction (arrow); B: Endoscopic retrograde cholangiopancreatography (ERCP) showing 1.5 cm CHD stricture suspicious for perihilar cholangiocarcinoma (CCA); C: Frond-like growth and neovascularization suggestive of neoplasm involving the CHD, later confirmed as perihilar CCA following SpyBite^TM Max biopsy (previously with negative cytology on initial ERCP); D and E: Multiple views of the hepatic ducts that demonstrate scant reactive changes (from prior plastic biliary stent) and proximal limit of disease extension/tumor mapping; F: ERCP confirming successful deployment of plastic biliary stent across CHD stricture and subsequent decompression of right hepatic duct.