Cholangioscopy; Evolution, Present & Future

Abstract

The main burden of pancreatobiliary diseases is stones and strictures of varied aetiology. Endoscopic retrograde cholangiopancreatography (ERCP) as a standard endoscopic intervention for biliary diseases has been established for decades for evaluating and managing biliary lesions with suspected malignancy, strictures, bile duct stones, cholangitis, and postsurgical complications like strictures and leakage.^1-6

Due to the two-dimensional imaging in fluoroscopy, ERCP has also distinct limitations, especially for the characterization of biliary strictures and the differentiation between inflammatory, malignant, or fibrotic pathogenesis. In addition, tissue sampling by ERCP-directed brushing has a low sensitivity and specificity.^7, 8 Furthermore, guide wire placement in complicated strictures, malignant stenosis, or after surgery can be difficult by using only fluoroscopy guidance. Similarly, in the case of CBD stones, stones above the stricture and large stones are also difficult to manage endoscopically. Transpapillar cholangioscopy allows direct visualization of the biliary system up to biliary branches of the second and third order.

The first generation of SOC was quite low in visualization quality due to a fibre optical probe. The introduction of the digital high-resolution cholangioscopy Spyglass DS^TM (Boston Scientific Coro., Natick, MA, USA) in 2015 has achieved much better biliary endoscopic imaging quality.