Skip to main content
SpringerLink
Log in

Therapeutic role of direct peroral cholangioscopy using an ultra-slim upper endoscope

  • Topics
  • Advances in therapeutic ultrasound and endoscopy in hepato-biliary-pancreatic diseases
  • Published:
Journal of Hepato-Biliary-Pancreatic Sciences

Abstract

Introduction

Peroral cholangioscopy provides direct visualization of the bile duct and facilitates diagnostic procedures and therapeutic intervention. The currently available mother–baby scope system is not widely used because of its disadvantages. Direct peroral cholangioscopy (POC) with a regular, ultra-slim, upper endoscope can provide a valuable and economic solution for evaluating bile duct lesions, although its therapeutic role in biliary tract disease is uncertain. We assessed the usefulness of direct POC with an ultra-slim endoscope for therapeutic application in patients with biliary diseases.

Methods

Several new techniques and accessories allow therapeutic intervention under direct POC using an ultra-slim upper endoscope with a larger, 2-mm working channel. Intracorporeal laser or electrohydraulic lithotripsy under direct POC is a main therapeutic intervention for patients with bile duct stones resistant to conventional endoscopic procedures. Tumor ablation therapy such as photodynamic therapy and argon plasma coagulation may be performed under direct POC. Direct POC can be applied to guide biliary interventions such as guidewire placement, stone removal, and migrated stent retrieval, using diverse accessories.

Conclusion

Direct POC with an ultra-slim upper endoscope allows therapeutic intervention for patients with biliary diseases. Enhancements of the endoscope and specialized accessories are expected to expand the therapeutic role of direct POC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

Abbreviations

POC:

Peroral cholangioscopy

CBD:

Common bile duct

ERCP:

Endoscopic retrograde cholangiopancreatography

IHD:

Intrahepatic duct

LL:

Laser lithotripsy

EHL:

Electrohydraulic lithotripsy

APC:

Argon plasma coagulation

PDT:

Photodynamic therapy

ENBD:

Endoscopic nasobiliary drainage

References

  1. Neuhaus H. Cholangioscopy. Endoscopy. 1992;24:125–32.

    Article  PubMed  CAS  Google Scholar 

  2. Kozarek R, Kodama T, Tatsumi Y. Direct cholangioscopy and pancreatoscopy. Gastrointest Endosc Clin N Am. 2003;13:593–607.

    Article  PubMed  Google Scholar 

  3. Larghi A, Waxman I. Endoscopic direct cholangioscopy by using an ultra-slim upper endoscope: a feasibility study. Gastrointest Endosc. 2006;63:853–7.

    Article  PubMed  Google Scholar 

  4. Itoi T, Kawai T, Sofuni A, Itokawa F, Tsuchiya T, Kurihara T, et al. Efficacy and safety of 1-step transnasal endoscopic nasobiliary drainage for the treatment of acute cholangitis in patients with previous endoscopic sphincterotomy (with videos). Gastrointest Endosc. 2008;68:84–90.

    Article  PubMed  Google Scholar 

  5. Mori A, Tatebe H, Ohashi N, Maruyama T, Sakai K, Shibuya T, et al. Balloon-assisted insertion of a cholangioscope into the common bile duct: a novel technique. Endoscopy. 2008;40(Suppl 2):E106–7.

    Article  PubMed  Google Scholar 

  6. Moon JH, Ko BM, Choi HJ, Hong SJ, Cheon YK, Cho YD, et al. Intraductal balloon-guided direct peroral cholangioscopy with an ultraslim upper endoscope (with videos). Gastrointest Endosc. 2009;70:297–302.

    Article  PubMed  Google Scholar 

  7. Choi HJ, Moon JH, Ko BM, Hong SJ, Koo HC, Cheon YK, et al. Overtube-balloon-assisted direct peroral cholangioscopy by using an ultra-slim upper endoscope (with videos). Gastrointest Endosc. 2009;69:935–40.

    Article  PubMed  Google Scholar 

  8. Arya N, Nelles SE, Haber GB, Kim YI, Kortan PK. Electrohydraulic lithotripsy in 111 patients: a safe and effective therapy for difficult bile duct stones. Am J Gastroenterol. 2004;99:2330–4.

    Article  PubMed  Google Scholar 

  9. Piraka C, Shah RJ, Awadallah NS, Langer DA, Chen YK. Transpapillary cholangioscopy-directed lithotripsy in patients with difficult bile duct stones. Clin Gastroenterol Hepatol. 2007;5:1333–8.

    Article  PubMed  Google Scholar 

  10. Farrell JJ, Bounds BC, Al-Shalabi S, Jacobson BC, Brugge WR, Schapiro RH, et al. Single-operator duodenoscope-assisted cholangioscopy is an effective alternative in the management of choledocholithiasis not removed by conventional methods, including mechanical lithotripsy. Endoscopy. 2005;37:542–7.

    Article  PubMed  CAS  Google Scholar 

  11. Mori A, Sakai K, Ohashi N, Maruyama T, Tatebe H, Shibuya T, et al. Electrohydraulic lithotripsy of the common bile duct stone under transnasal direct cholangioscopy. Endoscopy. 2008;40(Suppl 2):E63.

    Article  PubMed  Google Scholar 

  12. Moon JH, Ko BM, Choi HJ, Koo HC, Hong SJ, Cheon YK, et al. Direct peroral cholangioscopy using an ultra-slim upper endoscope for the treatment of retained bile duct stones. Am J Gastroenterol. 2009;104:2729–33.

    Article  PubMed  Google Scholar 

  13. Shim CS, Cheon YK, Cha SW, Bhandari S, Moon JH, Cho YD, et al. Prospective study of the effectiveness of percutaneous transhepatic photodynamic therapy for advanced bile duct cancer and the role of intraductal ultrasonography in response assessment. Endoscopy. 2005;37:425–33.

    Article  PubMed  CAS  Google Scholar 

  14. Siddique I, Galati J, Ankoma-Sey V, Wood RP, Ozaki C, Monsour H, et al. The role of choledochoscopy in the diagnosis and management of biliary tract diseases. Gastrointest Endosc. 1999;50:67–73.

    Article  PubMed  CAS  Google Scholar 

  15. Park DH, Park BW, Lee HS, Park SH, Park JH, Lee SH, et al. Peroral direct cholangioscopic argon plasma coagulation by using an ultraslim upper endoscope for recurrent hepatoma with intraductal nodular tumor growth (with videos). Gastrointest Endosc. 2007;66:201–3.

    Article  PubMed  Google Scholar 

  16. Brauer BC, Fukami N, Chen YK. Direct cholangioscopy with narrow-band imaging, chromoendoscopy, and argon plasma coagulation of intraductal papillary mucinous neoplasm of the bile duct (with videos). Gastrointest Endosc. 2008;67:574–6.

    Article  PubMed  Google Scholar 

  17. Shah RJ, Adler DG, Conway JD, Diehl DL, Farraye FA, Kantsevoy SV, et al. Cholangiopancreatoscopy. Gastrointest Endosc. 2008;68:411–21.

    Article  PubMed  Google Scholar 

  18. Wright H, Sharma S, Gurakar A, Sebastian A, Kohli V, Jabbour N. Management of biliary stricture guided by the Spyglass direct visualization system in a liver transplant recipient: an innovative approach. Gastrointest Endosc. 2008;67:1201–3.

    Article  PubMed  Google Scholar 

  19. Yagi J, Adachi K, Arima N, Tanaka S, Ose T, Azumi T, et al. A prospective randomized comparative study on the safety and tolerability of transnasal esophagogastroduodenoscopy. Endoscopy. 2005;37:1226–31.

    Article  PubMed  CAS  Google Scholar 

  20. Mori A, Ohashi N, Tatebe H, Maruyama T, Inoue H, Takegoshi S, et al. Autonomic nervous function in upper gastrointestinal endoscopy: a prospective randomized comparison between transnasal and oral procedures. J Gastroenterol. 2008;43:38–44.

    Article  PubMed  Google Scholar 

  21. Tarnasky PR, Cotton PB, Baillie J, Branch MS, Affronti J, Jowell P, et al. Proximal migration of biliary stents: attempted endoscopic retrieval in forty-one patients. Gastrointest Endosc. 1995;42:513–20.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Soon Chun Hyang University School of Medicine, Bucheon, Korea

    Jong Ho Moon, Hyun Jong Choi & Bong Min Ko

  2. Digestive Disease Center, Soon Chun Hyang University Bucheon Hospital, 1174 Jung-Dong, Wonmi-Ku, Bucheon, 420-767, Korea

    Jong Ho Moon

Authors
  1. Jong Ho Moon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hyun Jong Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bong Min Ko
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jong Ho Moon.

About this article

Cite this article

Moon, J.H., Choi, H.J. & Ko, B.M. Therapeutic role of direct peroral cholangioscopy using an ultra-slim upper endoscope. J Hepatobiliary Pancreat Sci 18, 350–356 (2011). https://doi.org/10.1007/s00534-010-0353-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00534-010-0353-6

Keywords

Search

Navigation