Per-oral cholangioscopy

Abstract

Direct endoscopic views of bile duct have been described in literature since the 1970s. Since then rapid strides have been made with the advent of technologically advanced systems with better image quality and maneuverability. The single operator semi-disposable per-oral cholangioscope and other novel methods such as the cholangioscopy access balloon are likely to revolutionize this field. Even though cholangioscopy is currently used primarily for characterization of indeterminate strictures and management of large bile duct stones, the diagnostic and therapeutic indications are likely to expand in future. The following is an overview of the currently available per-oral cholangioscopy equipments, indications for use and future directions.

A new hybrid anchoring balloon for direct peroral cholangioscopy using an ultraslim upper endoscope

“…In general, the peroral route is more feasible and more applicable than the invasive percutaneous transhepatic route. Nevertheless, the dedicated ‘mother–baby’ endoscopic system has many disadvantages, including economic and technical problems, which have limited its use in non‐academic settings . Direct POC using an ultraslim endoscope can overcome some of these deficiencies.…”

“…Nevertheless, the dedicated 'mother-baby' endoscopic system has many disadvantages, including economic and technical problems, which have limited its use in nonacademic settings. 7,17 Direct POC using an ultraslim endoscope 18 can overcome some of these deficiencies. It uses the conventional single-operator endoscopic platform, which provides high-quality endoscopic imaging and permits interventional procedures through a large working channel with a 2-mm diameter.…”

“…[4][5][6] Direct POC with an ultraslim endoscope has been reported to offer significant advantages, such as a singleoperator platform with high-quality endoscopic imaging, a larger working channel, and better efficacy and tolerability for therapeutic procedures. 7,8 Unfortunately, its clinical use is limited owing to the low and inconsistent success rates of the free-hand biliary insertion of even an ultraslim endoscope. Recently, reports have documented several specialized accessories that may be used with the flexible ultraslim endoscope in the proximal bile duct.…”

Hemobilia from Biliary Angiodysplasia Diagnosed with Cholangioscopy

“…However, DPC requires a larger sphincterotomy and dilated bile duct. 12 It also lacks of access to proximal common bile duct. Therefore, the proximal biliary angiodysplasia in our patient would have not been identified had we used DPC.…”

Endoscopic Evaluation of Biliary Strictures: Current and Emerging Techniques

“…Additionally, the procedure was limited by poor maneuverability, small instrument channels, and inadequate tip deflection. 62 The development of single-operator cholangioscopy has recently led to a resurgence of interest in the use of this technique. Cholangioscopic inspection of the epithelium may provide macroscopic clues pertaining to malignancy.…”