Abstract
A 46-year-old man was referred to our hospital for a detailed examination of the bile duct. Contrast-enhanced computed tomography showed enhanced wall thickness of the lower bile duct. Endoscopic ultrasonography (EUS) revealed a hypoechoic papillary lesion in the distal bile duct (Fig. 1a), and endoscopic retrograde cholangiography showed a filling defect. Per-oral direct cholangioscopy (POCS) using an ultrathin endoscope (EG-L580NW; Fujifilm, Tokyo, Japan) revealed flat, elevated lesions with a slightly reddish color (Fig.
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