Usefulness of a novel 11F digital single-operator cholangioscopy through a colonoscope in a patient with surgically altered anatomy

Digital single-operator cholangioscopy (DSOC) is useful for evaluating biliary tract malignancies.¹ However, DSOC is challenging in patients with surgically altered anatomy (SAA) due to the small channel diameter of the enteroscope. While DSOC insertion through the overtube is useful,^{2, 3} scope manipulation is challenging. Only small biopsy forceps are available with conventional DSOC, resulting in an insufficient specimen. Recently, a novel 11F DSOC (eyeMAX; Micro-Tech, Nanjing, China; working channel, 1.8 mm; working length, 2190 mm)⁴ was developed, allowing use of larger biopsy forceps than conventional DSOC.

A 65-year-old man, who had undergone extended right hepatectomy for cystadenocarcinoma of the liver and distal gastrectomy with B-II reconstruction for gastric cancer, presented to our hospital for a tumor located at the hepatic hilum. In the initial session, we inserted an endoscopic nasobiliary drainage tube after endoscopic papillary large balloon dilation (REN [13–15 mm]; Kaneka, Osaka, Japan) (Fig. 1). Postendoscopic retrograde cholangiopancreatography pancreatitis and bleeding from the tumor occurred, which were managed conservatively. In the next session, we inserted an 11F eyeMax into the bile duct over a 0.025 inch guidewire (VisiGlide2; Olympus, Tokyo, Japan) through a colonoscope (EC-760R-V/M; working length, 1330 mm; channel diameter, 3.8 mm; Fujifilm, Tokyo, Japan). A tumor with ulceration was visualized at the hepatic hilum with no evidence of tumor extending to B4 bifurcation or lower bile duct. Mapping biopsy (Radial Jaw 4P; cup diameter, 1.8 mm; Boston Scientific, MA, USA) revealed adenocarcinoma at the hepatic hilum and no malignancy at the B4 bifurcation or lower bile duct (Fig. 2). Although the recommended channel diameter of the 11F eyeMax is 4.2 mm, it can be inserted through a colonoscope with a 3.8 mm channel. Insertion of the 11F eyeMax is difficult when the colonoscope is bent, requiring straightening of the colonoscope. This method allows stable DSOC manipulation and sufficient tissue sample collection in patients with SAA.

Authors declare no conflict of interest for this article.