Ductoscopy

Abstract

In biliopancreatic diseases, radiography of the bile ducts (i.e. ERCP-endoscopic retrograde cholangiopancreatography) is still preferred over direct visualization of the ducts by endoscopy technique (i.e., cholangioscopy or pancreaticoscopy). However, indications for performing cholangioscopy are continually evolving. Excellent diagnostic qualities of visual correlation with radiography findings and steering of intraductal biopsy improve diagnostic validity. Additional intraductal treatment options are available with the use of cholangioscopy, i.e. laser or electro-hydraulic lithotripsy, tumour ablation, argon plasma coagulation and more. A range of technical solutions for cholangioscopy are currently at hand: direct cholangioscopy systems (e.g. prototypes, ultra-slim gastroscopes) and mother/baby systems (e.g. SpyGlass, SAMBA, Polyscope). They may be utilized in a retrograde vs. antegrade (percutaneous) approach. The need for two experienced investigators is limited to few practices. Furthermore, safety profiles have been greatly improved recently.