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Indications for Single-Operator Cholangioscopy and Pancreatoscopy: an Expert Review

  • Endoscopy (P Siersema, Section Editor)
  • Published:
Current Treatment Options in Gastroenterology Aims and scope Submit manuscript

Abstract

Purpose of review

Direct endoscopic visualization of the biliary and pancreatic ducts by single-operator cholangioscopy (SOC) and pancreatoscopy (SOP) is an expanding technique with an increasing number of indications. This review provides technical tips and tricks and a literature update on the usefulness of SOC and SOP in clinical practice.

Recent findings

SOC has shown a 91.3% and 87.3% diagnostic procedural success in indeterminate strictures and difficult stones respectively, with a 9.4%–16.4% complication rate. Although the interpretation of the images suspected for malignancy can be challenging, new classifications based in mucosal and vascular patterns as well as better devices are in development. A higher sensitivity has been associated to targeted biopsies, compared to brushing and blinded biopsies. Indeed, SOC has recently demonstrated a decrease in the number of procedures and costs when compared with endoscopic retrograde cholangiopancreatography. This technique has also been reported for many other diagnostic and therapeutic indications, such as cholangiocarcinoma staging and foreign body extraction. Similarly, diagnostic and therapeutic SOP in indeterminate strictures or pancreatic stones, and intraductal papillary mucinous neoplasms, has been successfully reported.

Summary

Research to date supports the use of cholangioscopy as a complementary examination in patients with indeterminate strictures, difficult stones and specific situations. In a near future, there will probably be new established indications, a better understanding of the imaging findings and a place of SOC/SOP as first line in selected scenarios.

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Papers of particular interest, published recently, have been highlighted as: • Of importance

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  1. Department of Hepato-Gastroenterology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium

    Enrique Pérez-Cuadrado-Robles & Pierre H. Deprez

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  1. Enrique Pérez-Cuadrado-Robles
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Correspondence to Pierre H. Deprez.

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Enrique Pérez-Cuadrado-Robles declares that he has no conflict of interest. Pierre H. Deprez declares that he is consultant for Boston Scientific.

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Pérez-Cuadrado-Robles, E., Deprez, P.H. Indications for Single-Operator Cholangioscopy and Pancreatoscopy: an Expert Review. Curr Treat Options Gastro 17, 408–419 (2019). https://doi.org/10.1007/s11938-019-00237-2

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