Cholangioscopy-assisted endoscopic mucosal resection for a mildly dysplastic lesion of the common bile duct: a pilot exploration for super minimally invasive surgery

A 61-year-old man underwent endoscopic retrograde cholangiopancreatography (ERCP) for common bile duct (CBD) stones in our hospital. We performed peroral cholangioscopy to confirm whether any remnant stones were left after basket extraction; however, a polypoid lesion with a wide base was found in the CBD ([Fig. 1] a). We performed biopsy under cholangioscopic guidance, with pathology results revealing mild dysplasia. This patient faced a dilemma: surgical treatment would be accompanied by relatively major trauma; however, follow-up observation carries a risk of lesion progression. Therefore, our team developed a kind of injection needle and a snare with electrocision function, which can be passed through the working channel of the cholangioscope. Subsequently, we confirmed the safety and feasibility of cholangioscopy-assisted endoscopic mucosal resection (CA-EMR) in the CBD in a porcine model [1]. In this study, we performed CA-EMR for the aforementioned patient and successfully resected the CBD lesion.