Intraductal biliary and pancreatic endoscopy: An expanding scope of possibility

Abstract

Intraductal endoscopy describes the use of an endoscope to directly visualize the biliary and pancreatic ducts. For many years, technological challenges have made performing these procedures difficult. The "mother-baby" system and other various miniscopes have been developed, but routine use has been hampered due to complex setup, scope fragility and the time consuming, technically demanding nature of the procedure. Recently, the SpyGlass peroral cholangiopancreatoscopy system has shown early success at providing diagnostic information and therapeutic options. The clinical utility of intraductal endoscopy is broad. It allows better differentiation between benign and malignant processes by allowing direct visualization and targeted sampling of tissue. Therapeutic interventions, such as electrohydraulic lithotripsy (EHL), laser lithotripsy, photodynamic therapy, and argon plasma coagulation (APC), may also be performed as part of intraductal endoscopy. I n t ra d u c t a l e n d o s c o p y s i g n i f i c a n t l y i n c r e a s e s the diagnostic and therapeutic yield of standard endoscopic retrograde cholangiography (ERCP), and as technology progresses, it is likely that its utilization will only increase. In this review of intraductal endoscopy, we describe in detail the various endoscopic platforms and their diagnostic and clinical applications.

Diagnostic accuracy of conventional and cholangioscopy-guided sampling of indeterminate biliary lesions at the time of ERCP: a prospective, long-term follow-up study

“…6 This system appears to have a number of improvements over previous cholangioscopy platforms. 6,7 Importantly, a dedicated mini-forceps biopsy (SpyBite; Boston Scientific) can be inserted through the working channel of the cholangioscope (SpyScope; Boston Scientific) for the purpose of obtaining forceps biopsy specimens under direct vision. On the backdrop of the disappointing yields of standard cytology brushings and biopsies, the ability to obtain targeted cholangioscopyguided biopsy specimens came with high expectations for significant improvement in our capabilities to acquire accurate tissue diagnosis of biliary lesions.…”

Endoscopic management of biliary strictures after liver transplantation

“…Use of new intraductal endoscopy technologies such as the SpyGlass direct visualization system (Boston Scientific, Natick, Mass. ), which allows visualization of the inner wall of the biliary tree and can act as the guidance system for passage of the guidewire through a tight stricture, has shown some early promise in this area [5,[98][99][100] . A recent case report detailed the use of methylene blue-aided chromoendoscopy via peroral cholangioscopy to successfully optically diagnose extensive ischemic-type non-anastomotic biliary lesions after transplant [101] .…”

Photodynamic Therapy for Cholangiocarcinoma

“…SOC is a platform initially designed to enhance diagnostic accuracy during ERCP by allowing guided biopsy. 45,46 Recently, our group compared patients who underwent PDT alone with patients who underwent PDT using SOC. 40 A total of forty-five patients (24 male, aged 67.3±10.6 years) were treated with PDT during a fiveyear period.…”