Cholesterol polyps in the distal common bile duct

Abstract

Rationale:Cholesterol polyps are rare in the common bile duct and difficult to diagnose.Patient concerns:The small polypoid lesions often go undetected when using routine imaging methods, such as ultrasonography.Diagnoses:We treated a patient with cholesterol polyps in the common bile duct. After failing to detect choleliths using ultrasonography, magnetic resonance cholangiopancreatography revealed mild dilation of the common bile duct. Choledochoscopy was performed during laparoscopic cholecystectomy, which revealed yellowish-white polyps circumferentially distributed across the luminal surface of the distal common bile duct. Histological examination of biopsy specimens indicated cholesterol polyps with characteristic foamy cells.Interventions:The patient was treated with ursodeoxycholic acid, and the number of polyps was found to have been reduced at the 6-week follow-up based on T-tube choledochoscopic examination.Outcomes:Recovery was unremarkable, and the ursodeoxycholic acid treatment was discontinued at the 6-month follow-up.Lessons subsections:Our findings suggest that this rare condition can be treated pharmacologically to avoid potential postsurgical complications following resection of the distal common bile duct.

Endoscopic mucosal resection of a bile duct polyp: A case report

“…Due to the low incidence rate and difficulty in diagnosis, bile duct polyps are rarely reported[2,7,17-19]. The precise cause of bile duct polyps has yet to be elucidated, although it is generally believed that long-term stimulation by cholangiolithiasis and chronic cholangitis is associated with the formation of bile duct polyps[20].…”

“…Bile duct polyps are often asymptomatic[2]. Bile duct polyps can lead to cholangiolithiasis, which can cause the bile duct to become obstructed; larger bile duct polyps can directly obstruct the bile duct[7,22].…”

“…Bile duct polyps are difficult to diagnose by B-mode ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI); however, bile duct polyps can sometimes be detected during surgery of the biliary tract[1-3]. However, the definitive diagnosis of bile duct polyps requires cholangioscopy or use of the SpyGlass system[2,4-6]. Traditional open abdominal surgery and snare polypectomy by choledochoscopy via the T-tube sinus tract can be used to resect bile duct polyps[2,7].…”

“…However, the definitive diagnosis of bile duct polyps requires cholangioscopy or use of the SpyGlass system[2,4-6]. Traditional open abdominal surgery and snare polypectomy by choledochoscopy via the T-tube sinus tract can be used to resect bile duct polyps[2,7]. However, these two methods require the surgeon to open the abdomen and cut the bile duct to place the “T” tube; consequently, these techniques are associated with several limitations, including increased trauma, pain, and cost[8].…”

Cholesterosis of the common bile duct successfully diagnosed macroscopically and histologically using the transpapillary approach

“…Cholesterosis is defined as the aggregation of foamy cells under the mucosa 1 . Although cholesterosis of the gallbladder is a common disease, cholesterosis of the common bile duct (CBD) is rare, with less than 40 cases reported, 2 and diagnosis is extremely difficult 3 . Since cholesterosis is basically a benign tumor, a direct visual examination and histopathological diagnosis is important to reduce unnecessary surgery, 4 and endoscopic retrograde cholangiopancreatography (ERCP) and its related procedure have great benefits for patients because of its less invasiveness and its simplicity.…”