Reply to Zimmer

We appreciate the comments of Dr. Zimmer regarding our study “Direct peroral cholangioscopy with a new anchoring technique using the guide probe of Kautz” [1].

Dr. Zimmer reports an interesting single case of an alternative direct peroral cholangioscopy technique after failure of freehand intubation. For biliary access he used a stiffening wire, which was originally developed to increase the stiffness of a colonoscope (FDSP-30260 /DM; Mandel & Rupp, Erkrath, Germany). For previously reported guide wire-assisted cholangioscopy techniques, the cholangioscopy success rate is less than 50 % [2]. It is possible that use of a stiffer wire, such as that used by Dr. Zimmer, may result in a higher cholangioscopy success rate. We think that a major disadvantage of all guide wire-assisted cholangioscopy techniques is that the guide wire “just” stabilizes the insertion of the cholangioscope, whereas balloon-assisted cholangioscopy, as well as our recently reported anchoring technique, allow anchoring of the catheter in the biliary tract [1] [2]. Therefore, further studies are needed to evaluate the success rate of this new stiffening wire-assisted cholangioscopy technique.

• References

• 1 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
• 2 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