Cholangioscopy involves the use of a small-caliber, flexible endoscope to directly inspect the biliary epithelium, perform sight-directed tissue sampling, and enable therapeutic procedures within the bile ducts. Technical improvements including improved imaging and wider-diameter working channels have led to increased clinical success and utility of cholangioscopy. Currently, the primary applications of cholangioscopy are indeterminate biliary strictures and treatment of difficult bile duct stones. Here we describe a case of a completely obstructed bile duct in a patient with duodenal adenocarcinoma with previously placed metallic biliary and duodenal stents. During ERCP, the biliary tree proximal to the stricture did not opacify (Fig. 1), and the wire could not be advanced proximal to the obstruction. The use of direct intraductal visualization afforded by cholangioscopy aided in the visualization of bile staining and subsequent deep biliary cannulation. This clinical scenario would otherwise have resulted in percutaneous transhepatic biliary drainage, EUS-guided hepaticogastrostomy, or EUS-guided biliary access, the latter of which would not have been possible because of the previously placed metal biliary and enteral stents. Further novel uses of cholangioscopy, like cholangioscopic-assisted deep biliary cannulation as described here (Video 1, available online at www.giejournal.org), are likely to be developed with further refinement of this technique.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Gastrointestinal Endoscopy
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
Published online: June 17, 2016Todd H. Baron, MD, G. S. Raju, MD, Editors for VideoGIE
Copyright © 2016 by the American Society for Gastrointestinal Endoscopy