Diagnosis of bile duct metastasis from gastric cancer by endoscopic retrograde cholangiopancreatography combined with choledochoscopy: A case report

Table 1 Timeline of treatments

Time	Symptoms	Interventions	Outcomes
August 2022	Epigastric pain	Gastroscopy indicated the mass with a size of 6 cm × 4.8 cm × 1.5 cm located at the gastric body near to gastric angle	Pathological examination revealed a poorly differentiated adenocarcinoma
September 2022	-	Exploratory laparotomy indicated liver metastasis	Completed 8 cycles of sindilizumab in combination with XELOX
April 2023	-	Total gastrectomy with Roux-en-Y anastomosis	Pathological examination revealed a poorly differentiated adenocarcinoma of the stomach with some signet ring cells
May 2023-November 2023	-	Sindilizumab combined with capecitabine	No abdominal pain. No recurrent tumor is identified on the follow-up PET/CT scan
December 2023	Right upper abdominal discomfort and jaundice with scleral icterus	Radiologic imaging showed high biliary obstruction	Jaundice and biochemical markers progressively worsened
		Oral hepatoprotective medications
		PTCD and PTGD
January 2024	-	ERCP combined with choledochoscopy	Liver function tests normalized, and abdominal discomfort was relieved. Pathological examination with immunohistochemical staining showed a poorly differentiated adenocarcinoma of common bile duct.
		Endoscopic bile duct biopsy
		Placement of a biliary stent
May 2024-August 2024	-	Oxaliplatin combined with raltitrexed	The patient rigorously complied with the prescribed chemotherapy regimen and exhibited no abdominal pain, fever, or jaundice throughout the therapeutic course
March 5, 2025	-	-	Died

XELOX: Capecitabine and oxaliplatin; PET/CT: Positron emission tomography/computed tomography; PTCD: Percutaneous transhepatic cholangial drainage; PTGD: Percutaneous transhepatic gallbladder drainage; ERCP: Endoscopic retrograde cholangiopancreatography.