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Updated: Jun 5, 2025

Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
Gastrointestinal: Direct Visualization of Biliary Tuberculosis
Aniwat Saleepol1, Thitinan Chulroek2, Thanrada Vimonsuntirungsri1
1Gastrointestinal Endoscopy Excellence Center, Division of Gastroenterology, Department of Medicine, Faculty of Medicine Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Background:
Biliary tuberculosis is a rare type of hepatobiliary tuberculosis. Clinical presentation, imaging, or cholangiogram are difficult to distinguish from other common causes of cholangiopathy or malignancy. Direct visualization of bile duct via cholangioscopy and targeted biopsy was introduced as one of effective investigations for tissue acquisition and diagnosis.
Case Report:
We present a case of biliary tuberculosis presented with pruritus, progressive painless jaundice and significant weight loss. Laboratory findings showed an obstructive jaundice. MRI showed multifocal bile duct stricture and intrahepatic duct stone. Single operator cholangioscopy revealed ductal stricture with papillary projection at common hepatic duct and pigmented stone. Targeted biopsy was performed, which showed non-necrotizing granulomatous inflammation and detection of Mycobacterium tuberculosis complex DNA.
Conclusion:
Direct visualization via cholangioscopy can aid and increase diagnostic yield of biliary tuberculosis.
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