LAUSR

Endoscopic retrograde cholangiopancreatography (ERCP) with biopsy is a gold-standard procedure for pathological assessment of spreading of cholangiocarcinoma [1, 2]. Tumor existence at landmark biliary bifurcations should be assessed to consider the indication and extent of surgical resection. However, technical difficulties in pushing biopsy forceps against a biliary bifurcation may inhibit precise target biopsy. Here, we present a simple modification of widely used biopsy forceps for highly selective biopsy at the bifurcation of bile ducts at segments II and III (B2 and B3) (▶Video 1). An 80-year-old woman with suspected hilar cholangiocarcinoma was referred to our centre for hepatopancreatoduodenectomy (▶Fig. 1). We conducted ERCP and obtained tissue specimens from hilar and distal bile ducts, all of which revealed adenocarcinoma. Tumor absence at the bifurcation of B2 and B3 was a prerequiE-Videos