Intraductal papillary mucinous neoplasm of the bile duct with gastric and duodenal fistulas

Figure 4 Cholangiogram using ultra-slim endoscope showed moderately to severely dilated common bile duct and both proximal intrahepatic duct with the amorphous, partial intraluminal filling in the bile duct (A-C) and the suction of thick mucus after advancement into bile duct and approach up to the cystic duct (black arrow) level using anchoring of the balloon catheter (blue arrow) was ineffective (D-F).