Endoscopic diagnosis and management of biliary neuroendocrine tumor with prior Roux-en-Y choledochojejunostomy: a case report

Abstract

A 74-year-old woman with a previous Roux-en-Y choledochojejunostomy presented with biliary sepsis, Escherichia coli bacteremia, and a left-sided intrahepatic biliary stricture. Initial management included percutaneous transhepatic cholangiography with external biliary drainage. Colonoscope-directed cholangioscopy enabled biopsies and balloon dilatation because of the colonoscope's suitable length and channel diameter. Histology revealed a poorly differentiated neuroendocrine tumor of the bile duct. Surgical resection was abandoned intraoperatively because of peritoneal metastases. Following chemotherapy, the patient re-presented with biliary sepsis. Endoscopic retrograde cholangiography using a pediatric colonoscope allowed placement of an uncovered self-expandable metal stent across the intrahepatic stricture. The patient underwent lutetium therapy and was clinically stable at 12-month follow-up. This case highlights biliary neuroendocrine tumor as a rare cause of stricture and demonstrates the utility of colonoscope-directed cholangioscopy and endoscopic retrograde cholangiography for diagnosis and management.