Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Casesol. Sep 26, 2019; 7(18): 2864-2870
Published online Sep 26, 2019. doi: 10.12998/wjcc.v7.i18.2864
Endoscopic mucosal resection of a bile duct polyp: A case report
Shu Yang, Li Yang, Xiang-Yang Wang, Yu-Ming Yang
Shu Yang, Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
Li Yang, Xiang-Yang Wang, Yu-Ming Yang, Department of Gastroenterology, Hunan Provincial People’s Hospital, Hunan Normal University, Changsha 410011, Hunan Province, China
Author contributions: Yang S drafted the manuscript; Yang S, Yang L, and Wang XY collected the clinical data from the patient; Yang YM performed the surgical treatment, designed the case report, and revised the manuscript. All authors have read and approved the final manuscript.
Informed consent statement: Consent was obtained from the patient’s son for the publication of this report, all accompanying images, and the video.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
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 which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yu-Ming Yang, MD, Professor, Department of Gastroenterology, Hunan Provincial People’s Hospital, Hunan Normal University, 61 Jiefang West Road, Changsha 410011, Hunan Province, China. akm762mm@163.com
Telephone: +86-731-85295126Fax: +86-731-85295126
Received: April 29, 2019
Peer-review started: May 9, 2019
Revised: July 12, 2019
Accepted: July 27, 2019
Article in press: July 27, 2019
Published online: September 26, 2019
Processing time: 148 Days and 17.5 Hours
Abstract
BACKGROUND

Bile duct polyps are difficult to diagnose and are usually excised by open abdominal surgery or snare polypectomy using choledochoscopy via the T-tube sinus tract. However, these two resection methods require the surgeon to open the abdomen and cut the bile duct to place the “T” tube. Moreover, simple snare polypectomy, without submucosal injection, can only remove pedunculated polyps and not flat polyps. Therefore, a new method is required for the excision of bile duct polyps, including flat polyps.

CASE SUMMARY

A 63-year-old woman was hospitalized following epigastric pain lasting a month. She had a 30-year history of cholelithiasis and had undergone cholecystectomy because of cholecystolithiasis, and had undergone cholangiolithotomy twice due to choledocholithiasis. Computed tomography (CT) and magnetic resonance imaging showed a communication between the bile duct and duodenal bulb. Inside the communication, CT showed a high-density shadow which was a hypointense lesion in T2 weighted image. The lesion showed no enhancement in T1 weighted image contrast enhanced. Gastroscopy revealed an incarcerated bile duct stone in the anterior wall of the duodenal bulb, which was removed with a basket under gastroscopy. Thereafter, a choledochoduodenal fistula was revealed. Finally, a flat polyp was detected in the lower part of the common bile duct and was removed by endoscopic mucosal resection (EMR) through the fistula. To our knowledge, this is the first reported case of the removal of a bile duct polyp using EMR.

CONCLUSION

EMR is a safe, effective, and low-cost method for the resection of all bile duct polyps.

Keywords: Case report; Cholangiolithiasis; Bile duct polyp; Endoscopic mucosal resection

Core tip: Bile duct polyps, including flat polyps, can be successfully resected by endoscopic mucosal resection (EMR). This method is safe, effective, and less invasive, with low pain, rapid rehabilitation, and low cost. Based on the literature search, this is the first reported case in the world on the resection of a bile duct polyp using EMR.