Advances in Therapeutic Cholangioscopy

Abstract

Nowadays, cholangioscopy is an established modality in diagnostic and treatment of pancreaticobiliary diseases. The more widespread use and the recent development of new technologies and accessories had renewed the interest of endoscopic visualization of the biliary tract, increasing the range of indications and therapeutic procedures, such as diagnostic of indeterminate biliary strictures, lithotripsy of difficult bile duct stones, ablative techniques for intraductal malignancies, removal of foreign bodies and gallbladder drainage. These endoscopic interventions will probably be the last frontier in the near future. This paper presents the new advances in therapeutic cholangioscopy, focusing on the current clinical applications and on research areas.

Possibilities of per-oral transpapillary cholangioscopy in oncological practice

“…Основным преимуществом данной платформы нынешнего поколения являются ее превосходное качество изображения и возможность использования узкоспектрального режима. Ряд недостатков ограничил использование данной системы: высокие эксплуатационные расходы, хрупкость «дочернего» холангиоскопа, необходимость в двух квалифицированных эндоскопистах, ограничения в возможностях отклонения дистального конца холангиоскопа и неоптимальные возможности внутрипросветного орошения [9][10][11].…”

“…свою очередь, вызывает цитотоксическую реакцию, последующую ишемию, некроз и апоптоз опухолевых клеток [9]. В рандомизированном исследовании с участием 32 пациентов с нерезектабельным раком желчных протоков, проведенном T. Zoepf и соавт., пациенты, рандомизированные на фотодинамическую терапию, имели среднюю продолжительность жизни 21 мес по сравнению с 7 мес в контрольной группе (p=0,0109) [29].…”

Biliary endoscopy in the management of primary sclerosing cholangitis and its complications

“…97 By means of this catheter, tasks such as irrigation of the bile duct, small tissue biopsies, as well as therapeutic procedures, such as lithotripsy and ablation, can be performed. 98 Cholangioscopy has the unique ability to examine biliary epithelial vascular patterns for abnormalities ( e.g. irregularly dilated tortuous vessels, also known as “tumor vessels”), which are highly sensitive and specific for malignancy when found in conjunction with abnormal targeted biopsies.…”

Cholangioscopy in the digital era

“…Photodynamic therapy involves administration of a photosensitizer intravenously that accumulates in tumor cells. This is followed by exposing the tumor to photocuring light cholangioscopically, which in turn generates a cytotoxic reaction, subsequent ischemia, necrosis and apoptosis of tumor cells (9). In a randomized trial of 32 patients with non-resectable bile duct cancer by Zoepf et al, patients randomized to photodynamic therapy had a median survival time of 21 months compared to 7 months in controls (P=0.0109) (49).…”