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. 2025 Nov;13(9):1652-1667.
doi: 10.1002/ueg2.70123. Epub 2025 Oct 21.

European Consensus Recommendations for Direct Cholangioscopy and Pancreatoscopy Using a Modified Delphi Process

Enrico Palmeri  1   2 , Sebastian Stefanovic  3 , Emine Gökce  1 , Velio Ascenti  4 , Andrea Anderloni  5 , Vincenzo Cennamo  6 , Frédéric Prat  7 , George Webster  8 , Deepak Joshi  9 , Jonathan Potts  10 , Terence Wong  11 , Kofi Oppong  12 , Martin James  13 , Matthew Huggett  14 , Jim Portal  15 , Pieter Jan de Jonge  16 , Mark Ellrichmann  17 , Juan J Vila  18 , Ignacio Fernandez-Urien  18 , Marianne Udd  19 , Leena Kylänpää  19 , Wim Laleman  20 , Jan Werner Poley  21 , Petko Karagyozov  22 , Frans van der Heide  23 , Jan J Koornstra  23 , Emad S Aljahdli  24 , Christian Gerges  25 , Rogier P Voermans  26 , George Goodchild  27 , Akin Inderson  28 , Stefano Francesco Crinó  29 , Marco J Bruno  16 , David M de Jong  16 , Pieter Hindryckx  1
Affiliations

European Consensus Recommendations for Direct Cholangioscopy and Pancreatoscopy Using a Modified Delphi Process

Enrico Palmeri et al. United European Gastroenterol J. 2025 Nov.

Abstract

Background and aim: Direct cholangioscopy and pancreatoscopy have become widely implemented techniques in the diagnostic and therapeutic algorithms of several pancreaticobiliary disorders. This study aimed to generate general and indication-specific European consensus recommendations on cholangioscopy and pancreatoscopy.

Methods: Supported by the available literature, statements were formulated and grouped into the following categories: (1) pre-procedural considerations, (2) general technical aspects, (3) biliopancreatic stones, (4) biliary strictures, and (5) other indications. The evidence level of each statement was determined using the GRADE methodology. Cholangioscopy experts were invited to participate in a modified Delphi process. When 80% consensus was not reached, the statement was modified based on expert feedback and subjected to an additional Delphi round. Statements were rejected if they failed to reach consensus after three Delphi rounds.

Results: Thirty cholangioscopy experts completed the Delphi process. Forty-two (97.6%) generated statements were accepted, of which 39 (92.9%) in the first Delphi round. 12 statements on preprocedural and periprocedural settings, 8 statements on biliopancreatic stones, 13 statements on biliary strictures, and 9 statements on other indications were accepted.

Conclusion: Using a modified Delphi process, we developed general and indication-specific consensus recommendations for cholangioscopy to guide clinical practice.

Keywords: CBD stones; ERCP; cholangioscopy; endoscopy; pancreatoscopy.

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Conflict of interest statement

1. Enrico Palmeri: None.

2. Sebastian Stefanovic: Speaker for Medip, Swixx Biopharma, Johnson&Johnson. Educational grant from Olympus.

3. Emine Gökce: None.

4. Velio Ascenti: None.

5. Andrea Anderloni: None.

6. Vincenzo Cennamo: Endokey srl, Endoplay srl, Meditalia Group srl, Olympus Italia, Boston Scientific.

7. Frederic Prat: None.

8. George Webster: Honoraria from Boston Scientific, Cook Medical, Q3 Medical.

9. Deepak Joshi: Honorarium from Boston Scientific, Cook Medical, Q3 Medical, Ipsen pharmaceuticals, Advanz pharma, Mirum, Taewong Medical.

10. Jonathan Potts: Honorarium Astra Zeneca. Consultancy for Perspectrum.

11. Terry Wong: None.

12. Kofi Oppong: None.

13. Martin James: Receives departmental preceptorship funding from Cook Medial and Boston Scientific and payments for training courses from Olympus Medical.

14. Matthew Huggett: None.

15. Jim Portal: Consultancy and Training for Boston Scientific.

16. Pieter Jan F. de Jonge: Consultancy and speaker fee for Boston Scientific, Cook Medical and Fujifilm.

17. Mark Ellrichmann: Research funding from Boston Scientific and Microtech and is a consultant and invited speaker for Boston Scientific, Microtech and Olympus.

18. Juan J. Vila. Consultancy for Boston Scientific. Lecturer for Cook Endoscopy, Olympus and Pentax.

19. Ignacio Fernández‐Urién: None.

20. Marianne Udd: None.

21. Leena Kylänpää: None.

22. Wim Laleman: Consultancy for Cook Medical, MRM Health, CSL Behring. Grant support from Boston Scientific.

23. Jan Werner Poley: Consultancy/speaker fee for Boston Scientific and Pentax Medical.

24. Petko Karagyozov: None.

25. Frans van der Heide: None.

26. Jan Jacob Koornstra: None.

27. Emad Aljahdli: Consultant and speaker for Boston Scientific and Olympus medical.

28. Christian Gerges: None.

29. Rogier P. Voermans: Research support from Taewoong. Consultancy and speaker fees from Cook Medical, Boston Scientific, Viatris and Taewoong.

30. George Goodchild: None.

31. Akin Inderson: Speaker fee from Olympus, Fujifilm and Micro‐Tech, consultant for Fujifilm and Micro‐Tech.

32. Stefano Francesco Crino: Consultant for AlphaTau and Oncosil medical. Paid speaker for Boston Scientific.

33. Marco J. Bruno: Boston Scientific: consultant, support for industry and investigator‐initiated studies; Cook Medical: consultant, support for industry and investigator‐initiated studies; Pentax Medical: consultant, support for investigator‐initiated studies; Mylan: support for investigator‐initiated studies; AMBU: consultant, support for investigator‐initiated studies; ChiRoStim: support for investigator‐initiated studies.

34. David M. de Jong: None.

35. Pieter Hindryckx: Consultant and/or speaker for Boston Scientific, FujiFilm, MedWork and Viatris.

Figures

FIGURE 1
FIGURE 1
Modified Delphi flowchart.
FIGURE 2
FIGURE 2
Algorithm for cholangioscopy and pancreatoscopy in biliary and pancreatic conditions.
See this image and copyright information in PMC

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