Intestinal metaplasia of the common bile duct – a rare finding as a cause of indeterminate biliary stricture evaluated by cholangioscopy: case report

Results A 75-year-old female patient underwent ERCP for obstructive jaundice at a secondary care hospital. Based on the endoscopic image an adenoma of the papilla was suspected, biopsies were taken, following endoscopic sphincterotomy (EST), common bile duct (CBD) clearance was performed. Histopathological analysis showed adenomatous hyperplasia. She was re-hospitalized for jaundice, biliary plastic stent was placed. Nine months later abdominal CT scan revealed dilated extrahepatic and intrahepatic ducts with the biliary stent in place and no pathology in the pancreas. She was referred to our center for ERCP. Fluoroscopy showed a stricture at the junction of the CBD and common hepatic duct. EST was extended and biliary plastic stent was replaced. Brush cytology samples were taken from the stricture showing high-grade dysplasia. The papilla was re-biopsied showing no signs of dysplasia or malignancy. For the direct visual evaluation of the indeterminate biliary stricture digital peroral single-operator cholangioscopy (SpyGlass DSII) was performed, which revealed a papillary structure. Cholangioscopy-assisted targeted biopsies were taken, and the plastic stent was exchanged. Histology from the strictured area revealed small bowel type intestinal metaplasia of the common bile duct. The patient was referred for surgical resection.