Update in Biliary Endoscopy

Abstract

Biliary endoscopy has seen the development of several new techniques in the last few years. Its current role includes direct diagnostic imaging, tissue sampling, early diagnosis and palliation of biliary tumors. Relatively new methods for biliary stones management are electrohydraulic lithotripsy combined with choledochoscope guidance and laser lithotripsy. Intraductal ultrasound, confocal laser endomicroscopy and optical coherence tomography are emerging, purely diagnostic endoscopic tools in biliary endoscopy. Cytological examinations such as digital imaging analysis and fluorescence in situ hybridization have the potential of becoming very important in the early diagnosis of biliary tumors. Direct visualization of the biliary mucosa and tissue sampling can be done with the last generation of cholangioscopes. All these tools are promising, especially for the ‘undetermined biliary strictures’. Improvements in quality of life, survival and biliary drainage in patients with non-operable cholangiocarcinoma have been reported after the application of both photodynamic therapy and high-dose rate intraluminal brachytherapy. Drug-eluting stents with incorporated anti-tumor agents designed to improve patency and reduce the risk of tumor ingrowth have already been tested, and other stents are under investigation as well.

Bile Duct Lithiasis Mimicking a Perihilar Cholangiocarcinoma—An Endless Dilemma: A Case Report

“…Future options for a third-level preoperative assessment, that might be deeply further developed, include the intraductal ultrasound and cholangioscopy, which have been used for an accurate description of the parietal alterations and to guide targeted biopsies. The usage of these technical assessments, although promising for their accuracy, are highly expert-dependent and still not widely available [17].…”

Endoscopic diagnosis of cholangiocarcinoma: From endoscopic retrograde cholangiography to bile proteomics

“…This technique provides epithelial and subepithelial visualization and incorporates dynamic information such as blood flow, contrast uptake, and leakage [34]. Fluorescein injected intravenously diffuses through the capillaries and stains the extracellular matrix of the surface epithelium [35]. The nuclei do not absorb the contrast and appear dark.…”

“…The nuclei do not absorb the contrast and appear dark. The difference in contrast allows architectural analysis of the surface mucosa [34,35]. Consequently, a differentiation of normal from neoplastic tissue is possible.…”

Manejo percutáneo y endoscópico combinado de las estenosis benignas de la vía biliar

“…Su etiología es variable y la heterogeneidad de su morfología y topografía determinan enfoques de manejo que incluyen procedimientos endoscópicos 6,21 , percutáneos 7 y derivaciones biliodigestivas 12,20 . Actualmente se observa una tendencia creciente a intentar el control mínimamente invasivo de la EBVB a través de la combinación de procedimientos percutáneos o endoscópicos, o de ambos, sostenidos en el tiempo tratando de posponer o evitar las intervenciones de reconstrucción del flujo biliar que en su evolución han demostrado propensión a recurrir en la problemática obstructiva [1][2][3] .…”