Patient Profile
Patient Name
Mr. Ramesh Nair
Consultant
Dr. Vipulroy Rathod
Diagnosis
Indeterminate Bile Duct Stricture — Diagnosed by Direct Visualisation and Targeted Biopsy on SpyGlass Cholangioscopy
Age / Gender
67 Years / Male
Hospital
Fortis Hospitals Limited, Mulund, Mumbai
Past History
Gallstone disease, cholecystectomy done 6 years ago · Hypertension, on regular medication · No prior liver disease
Patient Background
Mr. Ramesh Nair, a 61-year-old retired schoolteacher from Pune, Maharashtra, presented with painless yellowing of the eyes, dark urine, and mild itching over two weeks. An ultrasound followed by an MRCP showed a narrowing (stricture) in the mid bile duct, but imaging alone could not determine whether the narrowing was due to a benign scar, an inflammatory cause, or an early cancer. A standard ERCP with brush cytology at another centre came back inconclusive, leaving the diagnosis unresolved and the family anxious about the next step. Searching for a specialist experienced in advanced biliary imaging, they consulted a Gastroenterologist in Mumbai known for advanced third-space and biliary endoscopy. Dr. Vipulroy Rathod, Director of Gastroenterology at Fortis Mulund, recommended SpyGlass Cholangioscopy to directly visualise the stricture from inside the bile duct and take targeted biopsies under direct vision.
Symptoms
Painless jaundice
yellowing of the eyes and skin without abdominal pain
Dark-coloured urine
noticed over roughly two weeks
Pale, clay-coloured stools
intermittent, consistent with reduced bile flow
Mild generalised itching
particularly at night
Mild, unintentional weight loss
over the preceding month
Diagnostic Method
Ultrasound abdomen
showed dilated bile ducts with a stricture in the mid common bile duct
MRCP (Magnetic Resonance Cholangiopancreatography)
confirmed a focal biliary stricture but could not determine whether it was benign or malignant
ERCP with brush cytology (outside hospital)
obtained an inadequate, inconclusive sample; unable to confirm or exclude malignancy
SpyGlass Cholangioscopy
direct, single-operator visualisation of the stricture from inside the bile duct, identifying its surface pattern and guiding precise, targeted biopsies
SpyBite targeted biopsy
tissue taken under direct endoscopic vision from the exact area of concern, yielding a definitive histopathological diagnosis
Disease Diagnosed
Direct cholangioscopic visualisation and targeted biopsy confirmed the mid bile duct stricture to be benign and inflammatory in nature, with no evidence of malignancy — a diagnosis that standard ERCP brushings had failed to establish. As a specialist in advanced biliary endoscopy, Dr. Rathod identified SpyGlass Cholangioscopy as the technique capable of resolving this diagnostic uncertainty directly and safely, avoiding an unnecessary major surgical exploration.
Risks of Leaving an Indeterminate Bile Duct Stricture Undiagnosed
Risk of missing an early biliary cancer if the stricture is wrongly assumed to be benign
Unnecessary major surgery if a benign stricture is wrongly treated as malignant
Persistent jaundice, itching, and risk of cholangitis (bile duct infection) without a clear treatment plan
Delay in appropriate management while the underlying cause remains unconfirmed
Treatment Plan
Dr. Vipulroy Rathod performed SpyGlass Cholangioscopy with targeted SpyBite biopsies, allowing direct visual assessment of the stricture and precise tissue sampling to establish a definitive, actionable diagnosis.
Why Endoscopic Stenting Was Chosen Over Surgery
01 — Direct Visualisation of the Stricture
SpyGlass provides a real-time, high-definition view from inside the bile duct itself, something standard ERCP and cross-sectional imaging cannot offer.
02 — Targeted, Accurate Biopsies
Biopsies are taken precisely from the abnormal area under direct vision, markedly improving diagnostic accuracy over blind brush cytology.
03 — Avoids Unnecessary Major Surgery
A confirmed benign diagnosis spares the patient a major surgical exploration that would otherwise be considered when a stricture cannot be characterised.
04 — Single-Session, Minimally Invasive Procedure
Performed entirely through the endoscope in one session, with no abdominal incision and a short recovery period.
How the Procedure Was Performed
- ERCP access — the endoscope was passed to the level of the bile duct opening (papilla) in the duodenum.
- Selective bile duct cannulation — the bile duct was selectively accessed and a cholangiogram obtained to reconfirm the stricture’s location.
- SpyGlass insertion — the single-operator cholangioscope was advanced through the endoscope directly into the bile duct.
- Direct visualisation — the stricture was examined under direct high-definition vision, assessing its surface pattern and extent.
- SpyBite targeted biopsy — forceps passed through the cholangioscope obtained tissue samples from the precise area of concern.
- Biliary drainage — a stent was placed across the stricture to relieve the jaundice and restore bile flow.
- Post-procedure observation — the patient was monitored for pain, fever, and signs of pancreatitis or cholangitis before discharge planning.
Procedure Summary
| Procedure | SpyGlass Cholangioscopy with SpyBite targeted biopsy and biliary stent placement |
| Imaging Used | Fluoroscopy-guided ERCP with SpyGlass direct visualisation; correlation with prior MRCP |
| Duration | 75 minutes |
| Sedation | Deep sedation with anaesthesia support |
| Hospital Stay | One night, discharged after confirming no fever or pain |
Doctor’s Quote
“An indeterminate bile duct stricture is one of the most anxious situations in gastroenterology, because the difference between a benign narrowing and an early cancer changes everything about the treatment plan. SpyGlass Cholangioscopy lets us go inside the bile duct itself, see the stricture directly, and take a biopsy from exactly the right spot. For Mr. Nair, this gave us a clear, confirmed diagnosis and spared him a major surgical exploration that would otherwise have been considered. Precision at this stage is what protects the patient from both undertreatment and overtreatment.”
Dr. Vipulroy Rathod, FASGE | Gastroenterologist in Mumbai | Director, Gastroenterology and Hepatobiliary Sciences, Fortis Hospital Mulund
Post-Procedure Guidelines
Clear liquids initially, advancing to a normal diet over the next day as tolerated
Monitoring for fever, chills, or worsening abdominal pain suggestive of cholangitis or pancreatitis
Course of antibiotics as advised to reduce the risk of biliary infection after instrumentation
Watch for recurrence of jaundice or itching, and report promptly if it occurs
Review of the SpyBite histopathology report with Dr. Vipulroy Rathod to confirm the final diagnosis
Planned stent review and follow-up cholangioscopy or imaging as advised
Outcome
| Timepoint | Result |
| Within 24 hrs | Stable and comfortable, no fever, mild soreness only, tolerating liquids |
| Day 2 | Discharged from hospital on antibiotics and a normal diet |
| Histopathology | SpyBite biopsy confirmed a benign, inflammatory stricture with no evidence of malignancy |
| 1 Week | Jaundice visibly improving, itching resolved, eating normally |
| 1 Month | Bilirubin levels back to near-normal, stent functioning well |
| 3 Months | Follow-up review confirmed resolution of jaundice and a stable, benign stricture |
| 12 Months | Remained well with no recurrence; routine biliary follow-up ongoing |
Long-Term Expectations
With the nature of his bile duct stricture confirmed as benign through direct visualisation and targeted biopsy, Mr. Nair avoided an unnecessary major surgical exploration and was treated with a clear, targeted plan instead. He will continue periodic follow-up with Dr. Rathod, including stent review and repeat imaging or cholangioscopy if required, to confirm the stricture remains stable over time and to detect any change early should it occur.
Patient Feedback
“I had turned yellow and no one could tell me for certain whether it was cancer. That uncertainty was the hardest part. Dr. Rathod’s procedure let him actually see inside the duct and get a clear answer — it was benign. I cannot describe the relief my family and I felt.”
Ramesh Nair, 61 | Pune, Maharashtra
“We had been told the reports were inconclusive and were bracing ourselves for the worst. Dr. Rathod’s clear explanation and the precision of his procedure gave us a definite, reassuring diagnosis. We are truly grateful for his expertise and patience.”
Mrs. Sunita Nair, Patient’s Wife | Pune, Maharashtra
