Successful Forceps Biopsy of Carcinoma of the Distal Bile Duct Under Direct Visualization Using a Stone Retrieval Balloon Catheter.

We present the case of a 72-year-old woman with elevated hepatobiliary enzymes and a small mass in the distal bile duct near the papilla. Fluoroscopy-guided forceps biopsy initially yielded insufficient tissue. After endoscopic papillary large balloon dilation with sphincterotomy, a stone retrieval balloon was used to expose the tumor to the duodenum. Biopsy under direct visualization using standard forceps revealed adenocarcinoma. The technique may be useful for the biopsy of lesions located in the terminal segment of the distal bile duct.