Endoscopic approach to biliary diseases in 2020: Is there still a role for direct peroral cholangioscopy?

Cholangioscopy is increasingly used to complement to standard endoscopic retrograde cholangio-pancreatography (ERCP) as a diagnostic and therapeutic approach to biliary disorders, including biliary strictures and choledocholithiasis. Peroral cholangioscopy was first described in 1976, using a fiberoptic cholangioscope and mother-baby technique [1] [2]. However, the mother-baby technique, which uses a standard duodenoscope as a platform to advance a dedicated small caliber cholangioscope into the bile duct through the working channel of the duodenoscope, has never been widely adopted in clinical routine. This was mainly due to the fragility of the baby scope, its limited maneuverability, the minute accessory channel, and the need for a second experienced endoscopist [3]. A new video cholangioscope was introduced in 1999 with high-quality digital imaging [4]. However, two experienced operators were still needed for the procedure and the problem of the fragility of the baby scope and high associated costs for repairs persisted.

Publication History

Article published online:
16 September 2021

• References

• 1 Rösch W, Koch H. Peroral cholangioscopy in choledocho-duodenostomy-patients using the pediatric fiberscope. Endoscopy 1978; 10: 195-198
• 2 Nakajima M, Akasaka Y, Fukumoto K. et al. Peroral cholangiopancreatosocopy (PCPS) under duodenoscopic guidance. Am J Gastroenterol 1976; 66: 241-247
• 3 Beyna T, Farnik H, Sarrazin C. et al. Direct retrograde cholangioscopy with a new prototype double-bending cholangioscope. Endoscopy 2016; 48: 929-933
• 4 Igarashi Y, Ukita T, Inoue H. et al. Clinical evaluation of the peroral cholangioscopy using a new videoscope. Diagn Ther Endosc 1999; 5: 231-237
• 5 Chen YK, Pleskow DK. SpyGlass single-operator peroral cholangiopancreatoscopy system for the diagnosis and therapy of bile-duct disorders: a clinical feasibility study (with video). Gastrointest Endosc 2007; 65: 832-841
• 6 Larghi A, Waxman I. Endoscopic direct cholangioscopy by using an ultra-slim upper endoscope: a feasibility study. Gastrointest Endosc 2006; 63: 853-857
• 7 Moon JH, Ko BM, Choi HJ. et al. Intraductal balloon-guided direct peroral cholangioscopy with an ultraslim upper endoscope (with videos). Gastrointest Endosc 2009; 70: 297-302
• 8 Albert JG, Friedrich-Rust M, Elhendawy M. et al. Peroral cholangioscopy for diagnosis and therapy of biliary tract disease using an ultra-slim gastroscope. Endoscopy 2011; 43: 1004-1009
• 9 Lenze F, Nowacki TM, Beyna T. et al. Direct peroral cholangioscopy with a new anchoring technique using the guide probe of Kautz – first clinical experiences. Endoscopy 2017; 49: 909-912
• 10 Choi HJ, Moon JH, Ko BM. et al. Overtube-balloon-assisted direct peroral cholangioscopy by using an ultra-slim upper endoscope (with videos). Gastrointest Endosc 2009; 69: 935-940
• 11 Ishida Y, Itoi T, Okabe Y. Current status and future perspective in cholangiopancreatoscopy. Curr Treatment Options Gastroenterol 2019; 17: 327-341
• 12 Lee YN, Moon JH, Lee TH. et al. Prospective randomized trial of a new multibending versus conventional ultra-slim endoscope for peroral cholangioscopy without device or endoscope assistance (with video). Gastrointest Endosc 2020; 91: 92-101
• 13 Tringali A, Lemmers A, Meves V. et al. Intraductal biliopancreatic imaging: European Society of Gastrointestinal Endoscopy (ESGE) technology review. Endoscopy 2015; 47: 739-753
• 14 Gerges C, Beyna T, Tang RSY. et al. Digital single-operator peroral cholangioscopy-guided biopsy sampling versus ERCP-guided brushing for indeterminate biliary strictures: a prospective, randomized, multicenter trial (with video). Gastrointest Endosc 2019; 91: 1105-1113
• 15 Navaneethan U, Hasan MK, Kommaraju K. et al. Digital, single-operator cholangiopancreatoscopy in the diagnosis and management of pancreatobiliary disorders: a multicenter clinical experience (with video). Gastrointest Endosc 2016; 84: 649-655
• 16 Bokemeyer A, Gerges C, Lang D. et al. Digital single-operator video cholangioscopy in treating refractory biliary stones: a multicenter observational study. Surg Endosc 2019; 34: 1914-1922
• 17 Turowski F, Hügle U, Dormann A. et al. Diagnostic and therapeutic single-operator cholangiopancreatoscopy with SpyGlassDS™: results of a multicenter retrospective cohort study. Surg Endosc 2018; 32: 3981-3988
• 18 Bokemeyer A, Gross D, Brückner M. et al. Digital single-operator cholangioscopy: a useful tool for selective guidewire placements across complex biliary strictures. Surg Endosc 2019; 33: 731-737
• 19 Dumonceau JM, Tringali A, Papanikolaou IS. et al. Endoscopic biliary stenting: indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline – Updated October 2017. Endoscopy 2018; 50: 910-930
• 20 Beyna T, Gerges C, Esposito I. et al. Endobiliary polypectomy of biliary tumor using a prototype dedicated cholangioscope with double-bending technology. VideoGIE 2018; 3: 386-389