A polypoid mass in the common bile duct

Question: A 73-year-old woman with a prior history of cholecystectomy operation due to cholelithiasis was admitted to our clinic with complaints of abdominal pain in the epigastrium and right upper quadrant. Laboratory studies were unremarkable: Hb: 14.2 g/dL, hematocrit: 42.8%, WBC: 6000 /μL, platelet: 167000/μL, AST: 14 U/L, ALT: 16 U/L, ALP: 69 U/L, GGT: 42 U/L, total bilirubin: 0.57 mg/dL, and direct bilirubin: 0.32 mg/dL. Abdominal ultrasound examination showed dilatation of intrahepatic bile ducts. Endoscopic ultrasound (EUS) (Figure 1) and endoscopic retrograde cholangiopancreatography (ERCP) were then performed (Figure 2). During ERCP, the common bile duct was explored with a stone extraction balloon and a polypoid mass of 0.5 cm (Figure 3) came out of the common bile duct lumen, which was retrieved using a netted snare and sent to the pathology laboratory for histological examination (Figure 4).