Endoscopic Resection of a Biliary Fibrous Polyp Detected by Peroral Cholangioscopy Using a Rotatable Basket Catheter Under Fluoroscopic Guidance

Abstract

A 45-year-old woman was referred to our hospital with abdominal pain. Magnetic resonance cholangiopancreatography demonstrated a common bile duct (CBD) stone (Figure 1). Endoscopic retrograde cholangiopancreatography confirmed an impacted stone at the confluence of the cystic duct and the CBD. Because of distal bile duct narrowing, electrohydraulic lithotripsy was performed under peroral cholangioscopy (POCS), followed by stone extraction using a basket catheter. After stone removal, POCS revealed a protruding lesion at the cystic duct orifice (Figure 2). The lesion was isochromatic with the surrounding mucosa and was suspected to be an inflammatory polyp. Because its size and location made conventional cholangioscopic forceps inadequate for obtaining sufficient tissue, and direct cholangioscopic manipulation was limited by the narrow distal bile duct, the lesion was resected as a complete excisional biopsy to achieve both a definitive histopathological diagnosis and complete removal. Under fluoroscopic guidance, the lesion was gently captured with a rotatable basket catheter (RASEN2; KANEKA Medical, Japan). By carefully rotating the catheter, the lesion was detached, and complete excision was achieved without bleeding or perforation. Subsequent POCS confirmed complete resection endoscopically, with no residual lesion or procedure-related adverse events, thereby demonstrating the safety of this approach. Histopathological examination revealed an inflammatory fibrous polyp composed of fibrous stroma with mild epithelial proliferation and inflammatory cell infiltration. No recurrence was observed during follow-up [1-3]. This video demonstrates that a rotatable basket catheter, originally designed for bile duct stone extraction, can be considered a diagnostic and therapeutic option in carefully selected cases of intraductal biliary lesions when conventional cholangioscopic devices are not applicable.

T.U. contributed to the conception and design of the study, performed the endoscopic procedure, and drafted the manuscript. S.U. and S.K. contributed to data acquisition and interpretation. All authors critically revised the manuscript and approved the final version.

The authors have nothing to report.

The authors declare no conflicts of interest.