Intrahepatic cholangiocarcinoma diagnosed via endoscopic retrograde cholangiopancreatography with a short double-balloon enteroscope

Figure 1 Magnetic resonance imaging. A: The T2-weighted magnetic resonance imaging shows a hyperintense lesion along the dilated intrahepatic duct (arrows); B: Magnetic resonance cholangiopancreatography shows a stricture of biliary duct (arrow) with the upstream dilatation (arrowhead).

Figure 2 Endoscopic images during cannulation and transpancreatic sphincterotomy. A: Selective biliary cannulation was attempted in the position of the papilla moved to the lower endoscopic field of view; B: The wire-guided transpancreatic sphincterotomy was performed toward the biliary direction; C: The bile duct orifice was exposed after the transpancreatic sphincterotomy (arrow).

Figure 3 Endoscopic retrograde cholangiopancreatography. A: A guide wire was inserted deeply into the main pancreatic duct to perform the pre-cutting; B: After the pre-cutting, selective biliary cannulation was achieved; C: Cholangiography revealed a focal stricture in the branch of the right intrahepatic duct (arrow); D: A guide wire was passed through the biliary stricture; E: The brush cytological examination was carried out at the stricture; F: The placement of nasobiliary drainage tube was performed to collect the bile for cytology.