Hemobilia due to hepatocellular carcinoma: cholangioscopic findings and novel endoscopic hemostasis
Takeshi Ogura ∗, Atsushi Okuda, Kazuhide Higuchi
Second Department of Internal Medicine, Osaka Medical College, 2-7 Daigakuchou, Takatsukishi, Osaka 569-8686, Japan ∗Corresponding author.
E-mail address: in2121@osaka-med.ac.jp (T. Ogura)
Abstract：To the Editor:
Trauma, inflammation, iatrogenic procedures such as liver biopsy and percutaneous transhepatic biliary drainage (PTBD), vascular anomalies, coagulopathy status, and malignancy can cause hemobilia [1]. Malignant causes of hemobilia include cholangiocarcinoma, pancreatic cancer, gallbladder tumor, and liver metastasis, but rarely hepatocellular carcinoma (HCC). Here, we describe achieving endoscopic hemostasis for hemobilia caused by HCC, which was visualized using the single-operator, SPY-DS cholangioscope (Boston Scientific, Tokyo, Japan) under endoscopic retrograde cholangiopancreatography (ERCP) guidance. This scope is a dramatic improvement over the SpyGlass system in that it is easier to insert into the biliary tract due to a tapered tip, a 120° digital field-of-view provides favorable visualization, and new injection and suction functions have been added via a two-port adaptor.
2018, Vol. 17 
