Percutaneous transhepatic cholangioscopy-assisted biliary polypectomy for local palliative treatment of intraductal papillary neoplasm of the bile duct

Figure 1 Percutaneous transhepatic cholangioscopy-assisted biliary polypectomy for mucin-hypersecreting cast-like type intraductal papillary neoplasm of the bile duct with therapeutic success in patient one. A: Percutaneous transhepatic cholangioscopy (PTCS) showing frond-like tumors with vascular images in the hilar bile duct; B: Cholangiography showing multiple 1-cm sized stones in the left intrahepatic duct (arrow); C: PTCS showing a frond-like tumor that was being resected with the snare at the lower right in the visual field under PTCS; D: The cholangioscopic view of the location where the tumor was successfully resected with PTCS assisted biliary polypectomy (PTCS-BP); E: A scar (arrow) forming with a local minimal proliferated tumor (arrowhead) 2 wk after the last PTCS-BP; F: PTCS showing newly growing leaf-like tumors (arrows); G: Cholangiography showing a reduced biliary tract caliber, with a stenotic stiff and rigid ductal wall suspected of the existence of an invasive lesion in the left hepatic duct (arrow); H: Biopsies being taken from the site suspected of the existence of an invasive lesion 5 months after PTCS-BP.