ROLE OF PERORAL CHOLANGIOSCOPY IN THE PREOPERATIVE DIAGNOSIS OF MALIGNANT MIDDLE and LOWER BILE DUCT CANCERS: A PRELIMINARY STUDY USING 10 FR PLASTIC STENT

Abstract

To date, peroral cholangioscopy (POCS) with working channel for biopsy is a less than an essential means for endoscopic diagnosis of bile duct lesions. One of these reasons is that the durability of the baby scope is much improved, too delicate for use on tough lesions. Furthermore, in operable cases, it has a major disadvantage in that we cannot observe the proximal site of stricture. In this study, we introduced new methods to observe and perform the biopsy at proximal site of stricture using 10Fr plastic stent. After this method, we performed observation of proximal site of stricture without dilation and could diagnose precise incision line preoperatively in all cases. Importantly, all procedures were done within one week from the first endoscopic retrograde cholangiopancreatography (ERCP). Although further investigation and development of baby scopes are necessary, POCS using 10Fr plastic stent will make it possible to evaluate the hepatic site of spreading cancer in patients with middle or lower bile duct cancer.

Improvement of Choledochoscopy: Chromoendocholedochoscopy, Autofluorescence Imaging, or Narrow‐band Imaging

“…POCS and PTCS have played an important role in the diagnosis of biliary tract disease. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] Conventional choledochofiberscopy is poor due to low resolution and small image size. Newly available videocholedochoscopy can provide large image size and better imaging, as in the present cases.…”

“…Peroral choledochoscopy (POCS) [1][2][3][4][5][6][7][8][9][10][11][12] or percutaneous transhepatic choledochoscopy (PTCS) [13][14][15][16] were developed two to three decades ago as diagnostic endoscopy tools for observation of bile duct lesions that are difficult to differentiate on cholangiography and for accurate diagnosis in biopsy. To date, we have evaluated the observation of biliary tract disease using chromoendoscopy (CE) with methylene blue or autofluorescence imaging (AFI) in addition to conventional white light illumination.…”

Transcatheter endoscopy for pancreaticobiliary duct diseases (with videos)

“…[6][7][8][9] Recently, 3 new POCS techniques have been reported. One was direct endoscopic cholangioscopy, in which an ultraslim upper endoscope is advanced over a balloon catheter that has been inserted in the pancreatobiliary duct of the patient; this allows direct visual examination of the biliary and pancreatic ducts.…”

Endoscopic retrograde cholangiography versus peroral cholangioscopy to evaluate intraepithelial tumor spread in biliary cancer

“…In the present study, the distal side could be observed in all patients who underwent POCS. Regarding techniques that can be used to reach through the obstruction, it has been reported that using a 10-Fr plastic tube stent as part of the pretreatment enables the endoscope to be passed through the obstruction to observe the proximal side of the obstruction [8], thus compensating for the disadvantages of a transpapillary approach. The biliary drainage plastic tube stent, including the ENBD tube, may cause hyperplastic or regenerative changes in the mucosa, which has a scale-like appearance that is identifiable by POCS.…”