Fig. 1. Tumor extension into the distal common bile duct (CBD). (A) About 1.5 cm sized polypoid mass lesion was noted on major papilla. (B) Snare capturing for entire tumor was done. (C) After endoscopic papillectomy, the resection bed seems to be clear and no residual tumor tissue was noted. (D, E) Selective cannulation of main pancreatic duct was done and stenting with 5 cm long, 5 Fr diametered single pigtail stent was done. (F, G) Selective cannulation of CBD and endoscopic biliary sphincterotomy (EBST) was performed. After EBST, papillary mass lesion was protruded out from the distal CBD. (H) Using the snare and retrieval balloon extraction, further resection for extended tumor tissue in CBD was done. (I) After snare resection, ablative therapy using argon plasma coagulation (APC) was done. (J) After two sessions of further snare resection and APC ablative therapy, no residual tumor tissue was noted on papillectomy bed.
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