Per-oral cholangioscopy

Abstract

Direct endoscopic views of bile duct have been described in literature since the 1970s. Since then rapid strides have been made with the advent of technologically advanced systems with better image quality and maneuverability. The single operator semi-disposable per-oral cholangioscope and other novel methods such as the cholangioscopy access balloon are likely to revolutionize this field. Even though cholangioscopy is currently used primarily for characterization of indeterminate strictures and management of large bile duct stones, the diagnostic and therapeutic indications are likely to expand in future. The following is an overview of the currently available per-oral cholangioscopy equipments, indications for use and future directions.

Figure 1

Mother and baby cholangioscopy

Figure 2

A: SpyGlass™ direct visualization system; B: SpyScope™; C: SpyGlass™; D: SpyBite™.

Figure 3

A: Cook cholangioscopy access balloon; B: An ultraslim endoscope being pushed into the bile duct with the Cook cholangioscopy access balloon in situ.

Figure 4

A: Cholangiogram showing a filling defect in the left hepatic duct which could be a stone or a tumor; B: SpyGlass picture showing a nodular, irregular lesion suggestive of a malignancy; C: SpyGlass picture showing cholesterol stone in the bile duct.

Figure 5

Cholangioscopic views of cholangiocarcinoma showing a nodular lesion with thick circuitous vessels