case_images: PMC11424493_01
case_images: PMC11424493_02
case_images: Findings in Case 1. (a) Cholangiography revealing a defect (red arrow) in the distal bile duct and causing biliary stricture (blue arrow). (b) Cholangioscopy revealing a protruding lesion (red arrow) in the distal bile duct. (c) pCLE revealing "thick dark bands" (red arrow) indicating malignancy. (d) Histological findings from a surgical specimen showing adenocarcinoma (H&E, original magnification, x200). pCLE, probe-based confocal laser endomicroscopy; H&E, hematoxylin and eosin.
case_images: DEO2-5-e70007-g004.jpg
case_images: PMC11424493_02_DEO2-5-e70007-g004.jpg
case_images: deo270007-fig-0002
case_images: Cholangiography revealed a defect causing a stricture in the distal bile duct (Figure 2a). POCS revealed a protruding lesion in the distal bile duct (Figure 2b). Subsequently, pCLE under direct cholangioscopic visualization was performed, which revealed "thick dark bands" indicating malignancy (Figure 2c). Histological examination of the surgical specimen revealed adenocarcinoma (Figure 2d).
case_images: PMC11424493_03
case_images: PMC11424493_04
case_images: Findings in Case 2. (a) Cholangiography revealing a biliary stricture (red arrow) in the distal bile duct. (b) Cholangioscopy revealing the biliary stricture (red arrow) without any sign of malignancy. (c) pCLE revealing a "reticular network of thin dark branching bands," indicating a benign stricture. pCLE, probe-based confocal laser endomicroscopy.
case_images: DEO2-5-e70007-g003.jpg
case_images: PMC11424493_04_DEO2-5-e70007-g003.jpg
case_images: deo270007-fig-0003
case_images: Cholangiography revealed a stricture in the distal bile duct (Figure 3a). POCS also revealed biliary strictures; however, no malignant findings, such as irregular mucosa were observed (Figure 3b). pCLE under direct cholangioscopic visualization revealed a "reticular network of thin dark branching bands" indicating benign lesions (Figure 3c).
case_images: PMC11424493_05
case_images: Findings in Case 3. (a) Cholangiography revealing a stone (yellow arrow) and biliary stricture (red arrow) in the distal bile duct. (b) Endoscopic findings revealing successful stone extraction. (c) Cholangioscopy revealing a papillogranular surface without any irregularity (red arrow). (d) pCLE revealing a "thickened reticular structure" (red arrow), indicating inflammation. pCLE, probe-based confocal laser endomicroscopy.
case_images: DEO2-5-e70007-g002.jpg
case_images: PMC11424493_05_DEO2-5-e70007-g002.jpg
case_images: deo270007-fig-0004
case_images: Cholangiography revealed a stone and stricture in the distal bile duct (Figure 4a). Stone extraction and fluoroscopy-guided biopsy from the stricture site were performed (Figure 4b). POCS revealed a papillogranular surface without irregularities, indicating benign lesions (Figure 4c). pCLE under direct cholangioscopic visualization revealed a "thickened reticular structure" indicating inflammation (Figure 4d).