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Cholangioscopy and pancreatoscopy

Author
Raj J Shah, MD, FASGE, AGAF
Section Editor
Douglas A Howell, MD, FASGE, FACG
Deputy Editor
Anne C Travis, MD, MSc, FACG, AGAF

INTRODUCTION

Miniature endoscopes and catheters have been developed that permit direct visualization of the bile and pancreatic ducts (collectively known as cholangiopancreatoscopy). These endoscopes and catheters are passed through the working channel of a duodenoscope during endoscopic retrograde cholangiopancreatography (ERCP).

The first optical choledochoscope was described in 1941 [1], and the per oral approach was subsequently introduced in the early 1970s [2,3]. Continued refinements have resulted in commercially available small-diameter cholangiopancreatoscopes that include working channels and the ability to deflect the tip of the scope [4-6].

This topic will review cholangioscopy and pancreatoscopy performed during ERCP using commercially available instruments. ERCP and alternate approaches for direct bile duct visualization are discussed elsewhere. (See "Endoscopic retrograde cholangiopancreatography: Indications, patient preparation, and complications" and "Percutaneous transhepatic cholangioscopy".)

INDICATIONS

Cholangioscopy is primarily used for the treatment of difficult bile duct stones (image 1 and picture 1) and for the evaluation of indeterminate biliary strictures (ie, strictures that could not be diagnosed as being benign or malignant with sampling techniques such as brush cytology or biopsy) (image 2 and image 3 and image 4 and picture 2 and picture 3) [6-17]. During cholangioscopy, targeted biopsies of bile duct lesions can be obtained (picture 4). It can also be used to evaluate equivocal fluoroscopy findings during endoscopic retrograde cholangiopancreatography, to assess the extent of cholangiocarcinoma prior to surgery, and to identify of stones not seen by conventional cholangiography. In one series that included primary sclerosing cholangitis patients, 30 percent had stones that had been missed by cholangiography [11].

During cholangioscopy, bile duct stones can be fragmented using electrohydraulic or laser lithotripsy probes that are applied directly to the stones. (See "Electrohydraulic lithotripsy in the treatment of bile and pancreatic duct stones" and "Laser lithotripsy for the treatment of gallstones" and 'Efficacy' below.)

                        

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Literature review current through: Nov 2016. | This topic last updated: Mon Aug 03 00:00:00 GMT 2015.
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