Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. May 27, 2023; 15(5): 965-971
Published online May 27, 2023. doi: 10.4240/wjgs.v15.i5.965
Precise mapping of hilar cholangiocarcinoma with a skip lesion by SpyGlass cholangioscopy: A case report
Cheng-Han Chiang, Kuan-Chih Chen, Benedict Devereaux, Chen-Shuan Chung, Kuei-Chang Kuo, Chien Chu Lin, Cheng-Kuan Lin, Hsiu-Po Wang, Kuo-Hsin Chen
Cheng-Han Chiang, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Xin-Tai General Hospital, New Taipei 242063, Taiwan
Kuan-Chih Chen, Chen-Shuan Chung, Kuei-Chang Kuo, Chien Chu Lin, Cheng-Kuan Lin, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei 22060, Taiwan
Benedict Devereaux, Department of Gastroenterology, Royal Brisbane and Women's Hospital, Herston 4029, Queensland, Australia
Hsiu-Po Wang, Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei 10002, Taiwan
Kuo-Hsin Chen, Department of Surgery, Far Eastern Memorial Hospital, New Taipei 22060, Taiwan
Author contributions: Chiang CH and Chen KC contributed equally to this work; Chiang CH and Chen KC wrote the manuscript; Chen KH performed the surgery and revised the manuscript; Chiang CH, Chen KC, Devereaux B, Lin CC, and Chung CS performed the SpyGlass cholangioscopy; Kuo KC and Lin CK contributed to the literature review; Wang HP provided instruction of the procedure; All authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patients for the publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Kuo-Hsin Chen, MD, Attending Doctor, Chief Doctor, Department of Surgery, Far Eastern Memorial Hospital, No. 21 Section 2, Nanya S. Road, Banqiao District, New Taipei 22060, Taiwan.
Received: November 25, 2022
Peer-review started: November 25, 2022
First decision: February 15, 2023
Revised: March 7, 2023
Accepted: April 7, 2023
Article in press: April 7, 2023
Published online: May 27, 2023
Processing time: 182 Days and 4.3 Hours

Cholangiocarcinoma (CC) is a very aggressive cancer with a poor prognosis. As surgery is the only curative therapy, preoperative evaluation of the tumor extent is essential for surgical planning. Although high-quality image modalities such as computed tomography and magnetic resonance imaging have been used extensively in preoperative evaluation, the accuracy is low. To obtain precise localization of tumor spread arising from the hilar region preoperatively, the development of an acceptable imaging modality is still an unmet need.


A 52-year-old female presented to our emergency department with jaundice, abdominal pain, and fever. Initially, she was treated for cholangitis. Endoscopic retrograde cholangiopancreatography with the cholangiogram showed long segment filling defect in the common hepatic duct with dilatation of bilateral intrahepatic ducts. Transpapillary biopsy was performed, and the pathology suggested intraductal papillary neoplasm with high-grade dysplasia. After treatment of cholangitis, contrasted-enhanced computed tomography revealed a hilar lesion with undetermined Bismuth-Corlette classification. SpyGlass cholangioscopy showed that the lesion involved the confluence of the common hepatic duct with one skip lesion in the posterior branch of the right intrahepatic duct, which was not detected by previous image modalities. The surgical plan was modified from extended left hepatectomy to extended right hepatectomy. The final diagnosis was hilar CC, pT2aN0M0. The patient has remained disease-free for more than 3 years.


SpyGlass cholangioscopy may have a role in precision localization of hilar CC to provide surgeons with more information before the operation.

Keywords: Hilar cholangiocarcinoma, Jaundice, SpyGlass cholangioscopy, Bismuth-Corlette classification, Hepatectomy, Case report

Core Tip: The precise localization of hilar cholangiocarcinoma (CC) is important for surgical planning. This case highlights the important role that SpyGlass cholangioscopy can have in precise localization. However, SpyGlass cholangioscopy may be difficult to perform during the first encounter because of obstruction. A two-step approach for obstructive jaundice caused by hilar CC was proposed: (1) Insertion of biliary plastic stents to relieve jaundice and dilate the stricture site; and (2) Removal of biliary plastic stents after relieving jaundice and subsequent examination of hilar CC involvement by SpyGlass cholangioscopy.