Mucin-producing bile duct tumor treated successfully with endoscopic ultrasound-guided hepaticogastrostomy
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CASE REPORT
Mucin‑producing bile duct tumor treated successfully with endoscopic ultrasound‑guided hepaticogastrostomy Takeshi Okamoto1 · Kenji Nakamura1,2 · Katsuyuki Fukuda1 Received: 25 January 2020 / Accepted: 2 April 2020 © Japanese Society of Gastroenterology 2020
Abstract We report the case of an 82 year-old Japanese man with a history of multiple heart surgeries who presented with nausea and loss of appetite. Laboratory tests showed elevated liver and biliary enzymes. Imaging showed a possible space-occupying lesion within a dilated bile duct. Endoscopic retrograde cholangiography showed an intact ampulla of Vater with a visible mucus-filled orifice presenting a fish-mouth appearance and fluoroscopy showed a possible tumor-causing mild stenosis of the bile duct. Cholangioscopy revealed papillary protrusions in the common bile duct. Pathological evaluation was inconclusive but negative for malignancy. Patient was presumptively diagnosed with intraductal papillary neoplasm of the bile duct. Mucobilia caused repeated migration of metallic biliary stents, requiring numerous endoscopic interventions. Endoscopic ultrasound-guided hepaticogastrostomy was performed, as patient was no longer fit for surgery. All abdominal symptoms resolved and laboratory values normalized. Patient remained symptom-free during 12 months of follow-up. Keywords Mucin-producing bile duct tumor · Mucobilia · Endoscopic ultrasound-guided hepaticogastrostomy · EUS-BD · ERCP
Introduction Mucobilia, the accumulation of mucus in the biliary tree, is a rare cause of biliary obstruction resulting from mucin secretion by mucin-producing bile duct or pancreatic tumors. Margin-free resection is the treatment of choice, regardless of evidence of malignancy. Mucobilia treated with metallic biliary stents (MS) is associated with a high risk of stent migration, requiring repeated intervention. Endoscopic ultrasound-guided biliary drainage (EUSBD) is an option for patients who cannot be treated surgically and cannot be sufficiently treated by endoscopic retrograde cholangiopancreatography (ERCP). There are no reports of EUS-BD for biliary obstruction due to mucobilia. We present the case of a patient with a mucin-producing biliary tumor and obstructive jaundice secondary to * Kenji Nakamura [email protected] 1
Department of Gastroenterology, St. Luke’s International Hospital, 9‑1 Akashicho, Chuo‑ku, Tokyo 104‑8560, Japan
Department of Gastroenterology, Ichikawa General Hospital, Tokyo Dental College, 5‑11‑13, Sugano, Ichikawa, Chiba 272‑8513, Japan
2
mucobilia, treated with endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) following multiple complete distal migrations of uncovered MS.
Case report An 82 year-old Japanese man was referred to our hospital for evaluation of elevated biliary enzymes discovered during routine follow-up. Patient also reported nausea and loss of appetite beginning 3 days prior to his presentation. Patient had a past medical history of chronic heart failure, chronic liver disease, persistent atrial fi
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