The Use of Cholangioscopy In the Diagnosis of Indeterminate Biliary Strictures: A Case Report and Review of the Literature.

Biliary strictures or narrowing of a portion of the biliary tree can have benign and malignant etiologies. One third of these will originate from iatrogenic injury and these are typically managed endoscopically. We present the case of a 76-year-old man with history of laparoscopic cholecystectomy ten years prior, who presented with one week of jaundice, dark urine, and pruritus. Along with non-invasive biliary imaging, he underwent cholangioscopy during endoscopic retrograde cholangiopancreatography revealing inflammatory-appearing stenosis of the common hepatic duct with embedded suture material. The stenotic area was biopsied using mini forceps and subsequently dilated with a balloon dilator. A plastic biliary stent was placed with improvement in the patient's hepatic function, with final cytology and pathology being negative for malignancy. Cholangioscopy facilitated detailed visual inspection of strictures and biopsies under direct visualization. The visual impression increased the sensitivity of the biopsy and assisted in ruling out malignancy from the most critical portion of the stricture. While timing of cholangioscopy remains to be determined, its use is a valuable tool in the diagnosis of indeterminate biliary strictures.