Intraductal biliary polypectomy performed with a nasogastroscope

Computed tomography confirmed the recurrence of cholelithiasis in the common bile duct (CBD) and in the dilated right hepatic duct associated with atrophy of S6–7 hepatic segments (●" Fig.1). Multiple stones and pus were extracted from the CBD during endoscopic retrograde cholangiopancreatography, which revealed a tight stricture, which could not be bypassed using several guide wires and upstream dilation, and intraductal stones in the right hepatic duct. The duodenoscope was therefore replaced by a nasogastroscope (GIF-N180, Olympus) introduced with a 50cm overtube for stability, to allow visualization of the site of stenosis and removal of the stone in the right hepatic duct (●" Fig.2). A 6mm polyp (Paris 0–1sp) (●" Fig.3) was visualized below the stricture and was removed using a diathermy snare (SD-221L-25, Olympus) (●" Fig.4). This was followed by several targeted biopsies of the biliary stricture. Scopeswere exchanged over a 0.035 Jagwire to dilate the stricture using a 6mm×4cm Hurricane balloon, to extract pus and stones, and to place a 7-Fr plastic biliary stent. Histology showed no malignant cells, but revealed an inflammatory infiltrate in the biopsies and a fibroinflammatory polyp. During follow-up that lasted almost twoyears, the patient’s progresswas favorable, the stent was left in place for more than one year, and he experienced no recurrent cholangitis.