Diagnostic videocholangioscopy using narrow-band imaging and recanalization by rendezvous technique for difficult...

A 51-year-old man was hospitalized because of close examination for liver dysfunction. drip infusion cholangiography-computed tomography (DIC-CT) revealed a stricture located at the middle bile duct but normal biliary scintigraphy. Endoscopic retrograde cholangiopancreatography (ERCP) showed obstruction of bile duct. Although we tried to pass the stricture using several kinds of guidewire under direct vision of peroral cholangioscopy, recanalization could not be achieved. Then percutaneous transhepatic biliary drainage (PTBD) was conducted. Cholangioscopy using narrow band imaging showed no tumor vessel or irregular mucosa. The biopsy specimens obtained from both distal and proximal sides of stricture showed no malignancy. Eventually, a rendezvous technique was tried using guidewire under percutaneous transhepatic cholangioscopy (PTCS) direct vision. Fortunately, since a guidewire could advance into a tiny hole at the center of a scar and an endoscopic nasobiliary drainage (ENBD) tube could be placed across the biliary stricture. One week after placement of ENBD tube, a 10 Fr plastic stent was inserted and the PTBD tube was removed without procedure-related complication. Eight months later, the stent was removed and the chief complaint disappeared without liver dysfunction.