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Advanced Therapeutic Endoscopy for Pancreatico-Biliary Diseases pp 351–365Cite as

Peroral Cholangioscopy for the Diagnosis of Biliary Tract Diseases

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Abstract

Peroral cholangioscopy permits direct visualization and tissue sampling of indeterminate biliary lesions and treats difficult bile duct stones. Accurate differential diagnosis is essential in the planning of therapy, can avoid unnecessary surgery in cases of benign disease, and aids in assessing the potential resectability of tumors. The main indication of cholangioscopy is diagnosis of indeterminate biliary strictures, because brushing cytology and biopsies are limited by relative low sensitivity. Standard peroral cholangioscopy is a mother-baby system. The newly developed video peroral cholangioscope (CHF-B260: Olympus, Japan) can provide not only high-resolution digital images but also narrowband imaging which may identify neoplasm. Mother-baby scope system has not gained widespread acceptance, because of its fragility and the need for two skillful endoscopists. To overcome this disadvantage, single-operator system (SpyGlass: Boston Scientific, USA) was developed and used frequently. Recently, direct peroral cholangioscopy (DC) by using an ultraslim video scope has been reported. Compared to standard mother-baby system, DC has relatively large working channel and durability but technical difficulty in the insertion into the bile duct. In addition, intrahepatic bile duct exploration is arduous task for DC. A meta-analysis of SpyGlass cholangioscopy showed that targeted biopsies under cholangioscope cannot improve diagnostic power compared to conventional brush cytology and biopsies. Therefore better visualization is essential for improving sensitivity of malignant biliary strictures. In this chapter, we reviewed peroral cholangioscopy, focusing on diagnosis of the biliary tract diseases.

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Abbreviations

CT:

Computed tomography

ERC:

Endoscopic retrograde cholangiography

ERCP:

Endoscopic retrograde cholangiopancreatography

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Author information

Authors and Affiliations

  1. Department of Gastroenterology, Graduate School of Medicine Chiba University, Chiba, Japan

    Toshio Tsuyuguchi, Harutoshi Sugiyama, Yuji Sakai & Naoya Kato

Authors
  1. Toshio Tsuyuguchi
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  2. Harutoshi Sugiyama
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  3. Yuji Sakai
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  4. Naoya Kato
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Corresponding author

Correspondence to Toshio Tsuyuguchi .

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Editors and Affiliations

  1. Department of Internal Medicine, School of Medicine, University of Tokai, Isehara, Kanagawa, Japan

    Tetsuya Mine

  2. Sankikai Medical Corporation, Yokohama, Kanagawa, Japan

    Rikiya Fujita

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Tsuyuguchi, T., Sugiyama, H., Sakai, Y., Kato, N. (2019). Peroral Cholangioscopy for the Diagnosis of Biliary Tract Diseases. In: Mine, T., Fujita, R. (eds) Advanced Therapeutic Endoscopy for Pancreatico-Biliary Diseases. Springer, Tokyo. https://doi.org/10.1007/978-4-431-56009-8_30

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  • DOI: https://doi.org/10.1007/978-4-431-56009-8_30

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