Cholangioscopy not only enables the direct visualization of the biliary tree, but also allows for
forceps biopsy to diagnosis early
cholangiocarcinoma. Recently, some reports have suggested the clinical usefulness of direct peroral cholangioscopy (POC) using an ultra-slim
endoscope with a standard endoscopic unit by a single operator. Enhanced endoscopy, such as narrow band imaging (NBI), can be helpful for detecting early
neoplasia in the gastrointestinal tract and is easily applicable during direct POC. A 63-year-old woman with acute
cholangitis had persistent bile duct dilation on the left hepatic duct after common bile duct stone removal and clinical improvement. We performed direct POC with NBI using an ultra-slim upper
endoscope to examine the strictured segment. NBI examination showed an irregular surface and polypoid structure with
tumor vessels. Target biopsy under direct endoscopic visualization was performed, and
adenocarcinoma was documented. The patient underwent an extended left
hepatectomy, and the resected specimen showed early
bile duct cancer confined to the ductal mucosa.