Recent update of therapeutic application of peroral cholangioscopy

Abstract

Despite advancements in endoscopic retrograde cholangiopancreatography (ERCP), direct endoscopic visualization of the biliary tree by cholangioscopy is required to improve the diagnosis and treatment of the underlying disease. Although several types of peroral cholangioscopy (POC) systems are available, single-operator cholangioscopy (SOC) has been widely used for interventions in the biliary system. The first SOC was SpyGlass direct visualization system (Boston Scientific, Natick, MA, USA) expanded to a digital version of the SOC (SpyGlass DS; Boston Scientific). More recently, single-operator direct POC using an ultra-slim upper endoscope has been proposed. The remarkable developments in POC and available specialized accessories continue to improve therapeutic procedure of the biliary diseases. POC allows the visualization of bile duct stone and guide wire placement across difficult strictures and selective cannulation of the intrahepatic and cystic ducts. It is also demonstrating its utility in investigational applications such as intraductal ablation therapy for bile duct tumors, removal of foreign body in the bile duct and evaluation of hemobilia.

National Survey Regarding the Management of Difficult Bile Duct Stones in South Korea

“…Thus, several rescue techniques and alternative approaches have been invented to handle these difficulties, such as peroral cholangioscopy (POC)-guided laser or electrohydraulic lithotripsy, endoscopic mechanical lithotripsy, or papillary large balloon dilation with/without sphincterotomy. [2][3][4][5][6][7] However, there are limited data on clinical practice patterns for the management of difficult CBD stones; when and how to choose a rescue technique or alternative measure, and which largely depends on the operator's experience, preferences, and the availability of the armaments. Therefore, this study aimed to investigate practice patterns and endoscopists' preferences in terms of procedure types and techniques for managing difficult situations of bile duct stone clearance in South Korea.…”

Could the “SpyGlass Direct Visualization” System Open New Horizons for Treating Biliary Tract Diseases as a Percutaneous Cholangioscopy?

“…Recently, with the advance of miniaturizing technology it has become possible to take the cholangioscopy via a peroral route, referred to as “peroral cholangioscopy (POC).” This can be approached by two different strategies; direct intubation into the bile duct with an ultra-thin endoscope, which is referred to as direct POC and indirect intubation into the bile duct via the working channel of a duodenoscope with using a small-caliber cholangioscope, which is referred to as “mother-baby” endoscope system, or with a disposable access catheter equipped with optical probe, which is referred to as “SpyGlass direct visualization” system. 1 …”

“…In 2018, the new distal version of SpyGlass DS was released and had many advancements compared to original version introduced in 2006; 4 times greater resolution, wider 110° field of view, and completely disposable SpyScope DS catheter that is composed of optic probe and delivery catheter within one unified body. 1 …”