Biliary interventions using single‐operator cholangioscopy

Abstract

Cholangioscopy provides an opportunity to directly visualize the bile duct for diagnosing biliary lesions and for therapeutic interventions. Although there are different cholangioscopy techniques available, single‐operator cholangioscopy has gained widespread acceptance as the standard technique for interventions in the biliary system because of its ease of use and widespread availability. Single‐operator cholangioscopy can be used for both diagnostic and therapeutic indications in the biliary tract. Diagnostic cholangioscopy is used for direct evaluation of indeterminate bile duct strictures with biopsies, diagnosing filling defects in the bile ducts observed during endoscopic retrograde cholangiography (ERC) imaging, preoperative mapping of the precise location and extension of tumors of the biliary tract, and diagnosis of intraductal neoplasms. Therapeutic cholangioscopy is used for visually guided treatment of biliary stones that have failed extraction with conventional ERC techniques, residual or impacted stones by using intraductal lithotripsy, ablation of biliary tumors and for facilitation of guidewire advancement into selective intrahepatic ducts for adequate biliary drainage. In this review, we will focus on advances in the single‐operator cholangioscopy techniques in the diagnosis and management of biliary disorders.

Postsurgical bile duct disruption: Digital single-operator cholangioscopy-assisted recanalization

“…Biodegradable biliary stents show good technical and clinical success in biliary fistula treatment [4]. In this case, the cholangioscope was the key element for the described rendezvous, illustrating the diagnostic and therapeutic advantages of direct visualization of the biliary duct [5]. A multidisciplinary approach is crucial for a good clinical outcome in these challenging cases [2,3].…”

Single‐operator cholangioscopy‐guided biopsy of indeterminate bile duct strictures: Work in progress

“…Determining an accurate diagnosis in indeterminate biliary strictures is challenging, with historically low sensitivity of 50–60% as all presently available diagnostic modalities possess some degree of inherent limitations 1–3 . However, the development of the second‐generation single‐operator cholangioscopy system (SpyGlassDS; Boston Scientific, Watertown, MA, USA) has resulted in a significant improvement in the diagnostic sensitivity to 75–85%, and we have recently shown in a randomized trial that an accurate diagnosis can be established in 90% of patients with indeterminate biliary strictures 4,5 . Recently, new cholangioscopy biopsy forceps have been developed (SpyBite Max Biopsy Forceps; Boston Scientific) with a larger jaw outer diameter of 1.0 mm, with the aim of procuring a greater quantity of tissue.…”

“…[1][2][3] However, the development of the second-generation single-operator cholangioscopy system (SpyGlassDS; Boston Scientific, Watertown, MA, USA) has resulted in a significant improvement in the diagnostic sensitivity to 75-85%, and we have recently shown in a randomized trial that an accurate diagnosis can be established in 90% of patients with indeterminate biliary strictures. 4,5 Recently, new cholangioscopy biopsy forceps have been developed (SpyBite Max Biopsy Forceps; Boston Scientific) with a larger jaw outer diameter of 1.0 mm, with the aim of procuring a greater quantity of tissue. However, there are, to date, no studies comparing standard cholangioscopy biopsy forceps (SpyBite Biopsy Forceps) with these novel biopsy forceps in tissue procurement in indeterminate biliary strictures.…”

Characteristic endoscopic images of gallbladder lesions in resected post‐cholecystectomy specimens

“…1 Newly developed cholangioscopies enable targeted biopsy of bile duct lesions and classify benign and malignant lesions based on a speculum of biliary imaging findings. [2][3][4] In our previous experience using cholangioscopy for diagnosing GB carcinoma, 5 we expected that several GB lesions may be also endoscopically distinguished. Herein, we describe the characteristic endoscopic findings of major GB lesions.Resected GB specimens were collected immediately after cholecystectomy and were opened at the side contralateral to the liver bed, followed by flushing.…”