Therapeutic role of direct peroral cholangioscopy using an ultra‐slim upper endoscope

Abstract

Introduction Peroral cholangioscopy provides direct visualization of the bile duct and facilitates diagnostic procedures and therapeutic intervention. The currently available mother–baby scope system is not widely used because of its disadvantages. Direct peroral cholangioscopy (POC) with a regular, ultra‐slim, upper endoscope can provide a valuable and economic solution for evaluating bile duct lesions, although its therapeutic role in biliary tract disease is uncertain. We assessed the usefulness of direct POC with an ultra‐slim endoscope for therapeutic application in patients with biliary diseases. Methods Several new techniques and accessories allow therapeutic intervention under direct POC using an ultra‐slim upper endoscope with a larger, 2‐mm working channel. Intracorporeal laser or electrohydraulic lithotripsy under direct POC is a main therapeutic intervention for patients with bile duct stones resistant to conventional endoscopic procedures. Tumor ablation therapy such as photodynamic therapy and argon plasma coagulation may be performed under direct POC. Direct POC can be applied to guide biliary interventions such as guidewire placement, stone removal, and migrated stent retrieval, using diverse accessories. Conclusion Direct POC with an ultra‐slim upper endoscope allows therapeutic intervention for patients with biliary diseases. Enhancements of the endoscope and specialized accessories are expected to expand the therapeutic role of direct POC.

Technical improvement using ultra‐slim gastroscopes for direct peroral cholangioscopy: analysis of the initial learning phase

“…Direct peroral cholangioscopy (POCS) using ultra‐slim gastroscopes is an emerging technique for endoscopic investigation of biliary diseases . Its clinical usefulness has been already proven for the investigation of biliary strictures .…”

“…Its clinical usefulness has been already proven for the investigation of biliary strictures . In addition, POCS has been described for interventions such as dilatation or stone removal . POCS also has the potential to take targeted biopsies from suspicious lesions .…”

Hemobilia from Biliary Angiodysplasia Diagnosed with Cholangioscopy

“…In the era of advanced endoscopic technique, cholangioscopy allows direct visualization of the biliary system to determine the source of hemobilia. 1 , 2 , 3 , 7 - 11 Aydinli et al described the intraoperative application of cholangioscopy to determine the source of hemobilia in selected patient in order to guide surgical intervention. 7 A study by Green et al suggests that patients who are diagnosed adequately based on endoscopic and cholangioscopic findings do not require more definitive investigations.…”

Endoscopic diagnosis of biliary tract disease

“…Ultrathin videoendoscopes (5-6 mm diameter tip, with 2 mm working channel) may provide excellent digital imaging of the biliary mucosa, but the challenge remains as to how best to access the biliary tree, and maintain endoscope position. Direct peroral intubation of the biliary tree using ultrathin gastroscopes has been reported [17,18], but is technically challenging, mainly due to the need for sharp angulation in the duodenum. The most widely used technique involves initial wire placement within the biliary tree at standard ERCP, removal of the duodenoscope, leaving the wire in place, and subsequent insertion of the ultrathin endoscope over the wire.…”