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Transcatheter arterial chemoembolization (TACE) has been widely used as a palliative treatment for patients with unresectable hepatocellular carcinomas (HCCs) [1]. TACE is a relatively safe procedure, with a complication rate of < 1% [2]. Hemobilia after TACE has very occasionally been reported [3], but endoscopic visualization of hemobilia has not been reported. A 63-year-old man presented to our hospital with abdominal pain, fever, and jaundice. He had been diagnosed 3 months earlier with alcoholic liver cirrhosis and unresectable HCC (4 cm, segment 8), and had been treated with TACE in our hospital. His laboratory test results were as follows: total bilirubin 10.5mg/dL; aspartate transaminase 1098 IU/L; and alanine transaminase 891 IU/L. Computed tomography (CT) revealed newly developed intraductal masses or blood clots in the common bile duct (CBD) and intrahepatic duct (IHD), with upstream IHD dilatation. Endoscopic retrograde cholangiopancreatography (ERCP) revealed multiple filling defects in the bile duct (▶Fig. 1). Multiple blood clots were extracted with a stone basket and balloon catheter (▶Fig. 2). Therefore, hemobilia E-Videos

Transcatheter arterial chemoembolization-induced bile duct necrosis with hemobilia in hepatocellular carcinoma: endoscopic visualization and repair