Figure 1.

A case of bile duct stricture diagnosed as distal cholangiocarcinoma with an endoscopic scraper (Trefle^®). (a) Computed tomography scan and magnetic resonance cholangiopancreatography showed stenosis in the distal bile duct; (b) endoscopic retrograde cholangiography showed irregular stenosis in the distal bile duct; (c) tissue acquisition procedure by Trefle^® was performed for the stenosis in the distal bile duct; (d) the appearance of Trefle^® showed. The inner sheath includes a 0.635-mm guidewire lumen and three metallic loops for scraping. Bile juice can be aspirated from the space between the inner and outer sheath; (e) tissue specimens and cell samples obtained by Trefle^®; and (f) microscopic appearance of a hematoxylin and eosin-stained tissue sample appeared. The pathological diagnosis was adenocarcinoma.