No abstract

Choledochoscopy, or cholangioscopy, is an endoscopic procedure for direct visualization within the biliary tract for diagnostic or therapeutic purposes. Since its conception in 1879, many variations and improvements are made to ensure relevance in diagnosing and managing a range of intrahepatic and extrahepatic biliary pathologies. This ranges from improved visual impression and optical guided biopsies of indeterminate biliary strictures and clinically indistinguishable pathologies to therapeutic uses in stone fragmentation and other ablative therapies. Furthermore, with the evolving understanding of biliary disorders, there are significant innovative ideas and techniques to fill this void, such as nuanced instances of biliary stenting and retrieving migrated ductal stents. With this in mind, we present a review of the current advancements in choledo-choscopy with new supporting evidence that further delineates the role of choledochoscopy in various diagnostic and therapeutic interventions, complications, limitations and put forth areas for further study.

Purpose The COVID-19 pandemic and resultant lockdown measures potentially delay management of non-communicable, life-limiting diseases like colorectal cancer (CRC) through avoidance of healthcare facilities by the public and diversion of resources within healthcare systems. This study aims to evaluate the impact of Singapore’s “Circuit Breaker (CB)” lockdown measures on CRC disease presentation and short-term surgical outcomes, while comparing Singapore’s approach against other countries which employed similar lockdown measures. Methods Patients whose initial diagnosis of CRC was made within the 6-month pre-CB (6/10/19–6/4/20) (“pre-CB group”) and post-CB (7/4/20–7/10/20) (“post-CB group”) period were enrolled retrospectively. The groups were compared based on severity of disease on presentation and short-term operative outcomes. Results In total, 105 patients diagnosed with CRC were enrolled in this study. When comparing pre-CB and post-CB groups, there was no significant difference in stage of CRC on presentation ( p = 0.850). There was also no increase in need for emergent operations ( p = 0.367). For patients who had undergone an operation, postoperative morbidity was not significantly higher in the post-CB group ( p = 0.201). Both groups of patients had similar length of stay in the hospital ( p = 0.438). Conclusion Unlike similar high-income countries, Singapore did not see later stage disease on presentation and poorer operative outcomes after lockdown measures. Possible reasons include lesser healthcare avoidance behaviours amongst Singaporeans, and adequate preparation of resources and contingency plans formed by hospitals after previous pandemics.