“FLYING RIBBON” SIGN: A NOVEL CHOLANGIOSCOPY FEATURE OF CHOLANGIOCARCINOMA

A set of cholangioscopic features discriminating cholangiocarcinoma from benign biliary lesions has been described recently. These include ulceration, scarring, papillary projections, mass lesion, abnormal vessels, stricture, coarse granular mucosa and others. We are introducing a new feature named “flying ribbon” sign. It is defined as punctual spiral-like underwater bleeding resembling flying ribbon, occurring either spontaneously or after gentle contact of the tip of cholangioscope with a lesion.