Choledochal cysts are bile duct anomalies that range from dilatation of the main bile
duct to dilatation of the intrahepatic bile ducts (Caroli disease). The choledochocele
is a cystic dilatation of the intraduodenal portion of the bile duct, and is designated
type III in the Todani classification [1]; it represents less than 5 % of all choledochal cysts. When the choledochocele is
symptomatic, the incidence of carcinoma is estimated to be 2.5 % and this risk increases
with age [2]. Treatment by a single endoscopic sphincterotomy does not remove the risk of malignancy.
A 58-year-old woman, with a history of cholecystectomy, presented with acute pancreatitis.
The etiological investigation found a choledochocele on magnetic resonance cholangiopancreatography.
She was referred to North Hospital for endoscopic resection of the choledochocele.
Endoscopic retrograde cholangiopancreatography (ERCP) showed a 1.0-cm cystic mass
to the proximal side of the major papilla, which suggested a type IIIA choledochocele
([Video 1]). In the first step, a 25 × 55 mm snare (Cook Medical, Bloomington, Indiana, USA)
was deployed around the choledochocele. The snare was adjusted to capture the cystic
dilatation and the major papilla, and then a resection was performed using endocut
mode.
Endoscopic treatment of a choledochocele.
In the second step, the bile duct was cannulated using a CannulaTome (Cook Medical)
in order to place a 10 Fr × 9 cm plastic biliary stent (Cook Medical) following biliary
sphincterotomy. The pancreatic duct was then cannulated and a 5 Fr × 3 cm plastic
stent (Cook Medical) was placed.
The procedure was performed using carbon dioxide insufflation. The procedure was effective
at preventing post-ERCP pancreatitis. The resection was performed without complication.
The choledochocele was resected completely, and was 11 mm long in the major axis.
Histological analysis confirmed the presence of a cystic lesion, with part duodenal
and part biliary epithelia, and no tumor or dysplasia evident
Endoscopy_UCTN_Code_TTT_1AR_2AG
