Endoscopic mucosal resection for intra-ductal growing type intrahepatic cholangiocarcinoma under direct per-oral cholangioscopy.

The current standard treatment for intrahepatic cholangiocarcinoma is surgical resection. However, in case the patient does not agree with surgical resection or is not fit for surgery, there are a few alternative treatments. We present a case of an 83-year-old male patient with abdominal pain who was diagnosed with polypoid intrahepatic cholangiocarcinoma in the left intrahepatic duct (IHD) with peripheral IHD dilatation. He refused to undergo curative surgery. Alternatively, he underwent endoscopic mucosal resection (EMR) with direct peroral cholangioscopy (POC) using standard upper endoscopy with a transparent cap. At 1-year follow up, there was no evidence of locoregional recurrence or distant metastasis. We suggest that intraductal EMR could serve as an effective and safe alternative treatment for patients with polypoid intrahepatic cholangiocarcinoma using direct POC.