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Lee YN, Moon JH, Lee TH, Yoo HW, Yang JK, Cha SW, Cho YD, Park SH. Efficacy and safety of direct peroral cholangioscopy using a new multibending ultra-slim endoscope for the management of biliary diseases. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2022; 29:1292-1299. [PMID: 35658104 DOI: 10.1002/jhbp.1189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/21/2022] [Accepted: 05/01/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND/PURPOSE Compared with currently available duodenoscopy-assisted systems, direct peroral cholangioscopy (DPOC) using an ultra-slim endoscope is limited by technical difficulties. The multibending (MB) ultra-slim endoscope was introduced as a dedicated cholangioscope for DPOC to challenge the technical problem. We retrospectively analyzed the clinical utility of DPOC using an MB endoscope with free-hand insertion into the bile duct in patients with biliary diseases. METHODS A total of 145 patients who underwent DPOC using an MB endoscope were analyzed. The primary outcome was the technical success rate of DPOC using the free-hand insertion of the MB endoscope. The secondary outcomes were the technical success rates of DPOC-guided diagnostic and therapeutic interventions, the diagnostic accuracy of DPOC-guided target biopsy, and adverse events related to DPOC. RESULTS Free-hand biliary insertion of a MB endoscope for DPOC was technically successful in 133 patients (91.7%). DPOC-guided target biopsy was successful in 36 of 38 patients (94.7%) and had a diagnostic accuracy of 91.7% (95% confidence interval, 82.6-100). Sixty-nine therapeutic interventions were performed; technical success was achieved in 65 (94.2%). No severe adverse events were observed. CONCLUSIONS The MB ultra-slim endoscope was technically effective to perform a DPOC including various diagnosis and therapeutic interventions without device assistance. MB endoscope is considered to contribute to expanding a role of DPOC in diagnosis and treatment of diverse biliary tract diseases.
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Affiliation(s)
- Yun Nah Lee
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine, Bucheon, Korea
| | - Jong Ho Moon
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine, Bucheon, Korea
| | - Tae Hoon Lee
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine, Cheonan, Korea
| | - Hae Won Yoo
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine, Bucheon, Korea
| | - Jae Kook Yang
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine, Cheonan, Korea
| | - Sang-Woo Cha
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine, Seoul, Korea
| | - Young Deok Cho
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine, Seoul, Korea
| | - Sang-Heum Park
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine, Cheonan, Korea
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Chantarojanasiri T. Revolution of Novel Direct Peroral Cholangioscopy: Another Step Beyond Limitations. Gut Liver 2022; 16:499-500. [PMID: 35843684 PMCID: PMC9289838 DOI: 10.5009/gnl220274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Tanyaporn Chantarojanasiri
- Division of Gastroenterology, Department of Internal Medicine, Rajavithi Hospital, Rangsit University, Bangkok, Thailand
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Arai J, Kato J, Toda N, Kurokawa K, Shibata C, Kurosaki S, Funato K, Kondo M, Takagi K, Kojima K, Ohki M, Seki M, Tagawa K. Long-term survival after palliative argon plasma coagulation for intraductal papillary mucinous neoplasm of the bile duct. Clin J Gastroenterol 2020; 14:314-318. [PMID: 32779145 DOI: 10.1007/s12328-020-01199-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 07/25/2020] [Indexed: 12/15/2022]
Abstract
Intraductal papillary mucinous neoplasm of the bile duct (IPNB) is an epithelial tumor that can cause obstructive jaundice and cholangitis due to mucin production. Although the effectiveness of argon plasma coagulation in IPNB treatment has been demonstrated, the long-term effect of the therapy is largely unknown. Here, we have presented a patient with IPNB who underwent argon plasma coagulation with a follow-up period of more than 2 years. A 74-year-old woman was referred to our department for treatment of obstructive jaundice. Endoscopic retrograde cholangiopancreatography revealed marked dilation of intrahepatic and extrahepatic bile ducts and thick mucin drainage from the ampulla of Vater. IPNB was diagnosed pathologically from biopsy specimens. Surgery was not recommended because of the extensive intrahepatic spread of the lesion. Endoscopic sphincterotomy, endoscopic papillary large balloon dilation, and insertion of a metallic stent could not resolve the obstructive jaundice. Finally, argon plasma coagulation with percutaneous cholangioscopy was performed 3 times over 1 month. After treatment, obstructive jaundice was resolved and the patient's clinical condition has been stable for more than 2 years, except for a single episode of transient cholangitis. In conclusion, argon plasma coagulation may be an alternative to surgery for the palliation of jaundice with IPNB.
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Affiliation(s)
- Junya Arai
- Department of Gastroenterology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Jun Kato
- Department of Gastroenterology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Nobuo Toda
- Department of Gastroenterology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan.
| | - Ken Kurokawa
- Department of Gastroenterology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Chikako Shibata
- Department of Gastroenterology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Shigeyuki Kurosaki
- Department of Gastroenterology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Kazuyoshi Funato
- Department of Gastroenterology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Mayuko Kondo
- Department of Gastroenterology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Kaoru Takagi
- Department of Gastroenterology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Kentaro Kojima
- Department of Gastroenterology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Masataka Ohki
- Department of Gastroenterology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Michiharu Seki
- Department of Gastroenterology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Kazumi Tagawa
- Department of Gastroenterology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan
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Ishida Y, Itoi T, Okabe Y. Current Status and Future Perspective in Cholangiopancreatoscopy. ACTA ACUST UNITED AC 2019; 17:327-341. [DOI: 10.1007/s11938-019-00238-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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He S, Liu X, Du G, Chen W, Ruan W. Clinical study of the use of gastroscopy as oral choledochoscopy. Exp Ther Med 2018; 16:1333-1337. [PMID: 30116382 PMCID: PMC6090292 DOI: 10.3892/etm.2018.6320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 05/24/2018] [Indexed: 02/07/2023] Open
Abstract
Clinical value and safety of the use of gastroscopy as oral choledochoscopy in the treatment of biliary diseases was explored. Clinical data of 55 patients with biliary diseases who underwent gastroscopy were retrospectively analyzed. The types of gastroscopy, size of duodenal papilla incision, balloon dilatation, the success rate of gastroscopy entry, depth of gastroscopy entering into bile duct, endoscopic diagnosis and postoperative complications were recorded. Simple insertion-by-hand was performed, and insertion into common bile duct was successfully achieved in 53 cases, and the overall technical success rate was 96.4%. Residual bile duct stones in 25 patients (45.5%) after endoscopic retrograde cholangio-pancreatography (ERCP) were removed through endoscopy. Nine cases of benign stenosis and 2 cases of malignant stenosis were confirmed as ‘cholangiocarcinoma’ or ‘duodenal papilla well-differentiated adenocarcinoma’ by biopsy. Balloon oppression under intraoperative endoscopy was performed for 2 cases (3.6%) with biliary hemorrhage, and argon ion coagulation was successfully performed. No obvious abnormalities were found in 13 cases (23.6%) through gastroscopic biliary exploration. Complications occurred in 15 patients with a complication rate of 27.3%, including 2 cases of cholecystitis (3.6%), 8 cases of amyloidosis (14.6%) and 4 cases of acute pancreatitis (7.3%), and all those complications were cured. One case (1.8%) had perforation of biliary tract and was discharged after conservative treatment. The use of gastroscopy as oral choledochoscopy is safe as effective. However, this technique causes some rare and serious complications. Therefore, further studies are needed to improve this technique.
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Affiliation(s)
- Shunhui He
- Department of Gastroenterology, Shunde Hospital of Southern Medical University, Foshan, Guangdong 528300, P.R. China
| | - Xuehua Liu
- Department of Gastroenterology, Shunde Hospital of Southern Medical University, Foshan, Guangdong 528300, P.R. China
| | - Guoping Du
- Department of Gastroenterology, Shunde Hospital of Southern Medical University, Foshan, Guangdong 528300, P.R. China
| | - Wenzhi Chen
- Department of Gastroenterology, Shunde Hospital of Southern Medical University, Foshan, Guangdong 528300, P.R. China
| | - Weiqing Ruan
- Department of Health Management, Nanfang Hospital, Guangzhou, Guangdong 510515, P.R. China
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Li J, Guo SJ, Zhang JC, Wang HY, Li K, Niu SH. A new hybrid anchoring balloon for direct peroral cholangioscopy using an ultraslim upper endoscope. Dig Endosc 2018; 30:364-371. [PMID: 29168231 DOI: 10.1111/den.12989] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 11/17/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIM Large impacted or residual invisible common bile duct (CBD) stones after mechanical lithotripsy are challenging. We aimed to evaluate the feasibility and success rate of a new hybrid anchoring balloon-guided direct peroral cholangioscopy (POC) for these conditions using an ultraslim endoscope. METHODS Sixty-five patients with large or residual invisible CBD stones for direct POC from July 2012 to July 2016 were identified, including six cases in whom an additional interventional procedure was required. There were altogether 55 cases undergoing a procedure with our new device, with a 0.021-inch guidewire tied to a balloon catheter at its distal end in this single-center retrospective study. Technical success, procedure time, diagnostic and therapeutic efficacy of direct POC, and procedure-related complications were studied. RESULTS The hybrid anchoring balloon-guided direct POC was successful in 51/55 (92.7%) procedures, including 18 cases in whom the conventional wire-guided method failed within 25 min. Mean time for technical success by our method was 12.4 ± 3.4 min. In total, of the 43 cases with previous removal of CBD stones, seven (16.3%) were found to have residual stones ≥4 mm, excluding three cases in whom direct POC failed. In another 25 cases for difficult stones, 24 lithotripsies were carried out, resulting in 23 complete fragmentations. No significant procedure-related complications were observed. CONCLUSION The new hybrid anchoring balloon device performs well in facilitating direct POC using an ultraslim endoscope for evaluation and extraction of residual or large impacted CBD stones.
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Affiliation(s)
- Jian Li
- Endoscopy Unit, Department of Gastroenterology, Shenzhen Affiliated Hospital, Guangzhou University of Traditional Chinese Medicine, Shenzhen, China
| | - Shao-Ju Guo
- Endoscopy Unit, Department of Gastroenterology, Shenzhen Affiliated Hospital, Guangzhou University of Traditional Chinese Medicine, Shenzhen, China
| | - Jing-Chao Zhang
- Endoscopy Unit, Department of Gastroenterology, Shenzhen Affiliated Hospital, Guangzhou University of Traditional Chinese Medicine, Shenzhen, China
| | - Hong-Yan Wang
- Endoscopy Unit, Department of Gastroenterology, Shenzhen Affiliated Hospital, Guangzhou University of Traditional Chinese Medicine, Shenzhen, China
| | - Kai Li
- Endoscopy Unit, Department of Gastroenterology, Shenzhen Affiliated Hospital, Guangzhou University of Traditional Chinese Medicine, Shenzhen, China
| | - She-Hui Niu
- Endoscopy Unit, Department of Gastroenterology, Shenzhen Affiliated Hospital, Guangzhou University of Traditional Chinese Medicine, Shenzhen, China
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Huang YH, Chang H, Yao W, Zhang YP, Li K, Wang Y. A snare-assisted peroral direct choledochoscopy and pancreatoscopy using an ultra-slim upper endoscope: A case series study. Dig Liver Dis 2017; 49:657-663. [PMID: 28179089 DOI: 10.1016/j.dld.2017.01.150] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 01/05/2017] [Accepted: 01/11/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the feasibility, effectiveness and safety of a new snare-assisted peroral direct choledochoscopy/pancreatoscopy (PDCPS) technique. METHODS From November 2014 through December 2016, 20 consecutive patients with indications for PDCPS were enrolled in this observational study. Endoscopic retrograde cholangiography was initially performed using a conventional duodenoscope, and endoscopic papillary balloon dilation was performed. Next, an ultra-slim endoscope was inserted to perform the PDCPS; a snare tightened around the end of the scope's bending section facilitated its entry into the common bile duct (CBD). The primary endpoint was the overall success rate of the PDCPS procedure (successful biliary intubation and visualization of the area of interest) and the time for biliary intubation with the ultra-slim upper endoscope. RESULTS Participants (11 men and 9 women; mean age, 72.2 years [range, 41-93 years]) had CBD adenoma (n=1), large CBD stones after failed extraction/lithotripsy treatment (n=13), CBD strictures (n=4), pancreatic duct tumor (n=1) or pancreatic duct dilation (n=1). The success rate was 95%. The mean intubation time was 18min (range, 4-57min). No adverse events were reported. CONCLUSIONS A snare-assisted PDCPS technique appears to be technically feasible, effective and safe for both diagnostic and therapeutic applications.
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Affiliation(s)
- Yong-Hui Huang
- Department of Gastroenterology and Hepatology, Peking University Third Hospital, Beijing, China.
| | - Hong Chang
- Department of Gastroenterology and Hepatology, Peking University Third Hospital, Beijing, China
| | - Wei Yao
- Department of Gastroenterology and Hepatology, Peking University Third Hospital, Beijing, China
| | - Yao-Peng Zhang
- Department of Gastroenterology and Hepatology, Peking University Third Hospital, Beijing, China
| | - Ke Li
- Department of Gastroenterology and Hepatology, Peking University Third Hospital, Beijing, China
| | - Ye Wang
- Department of Gastroenterology and Hepatology, Peking University Third Hospital, Beijing, China
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8
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Shi D, Wu D. Advances in direct peroral cholangioscopy using an ultrathin endoscope. Shijie Huaren Xiaohua Zazhi 2016; 24:1791-1796. [DOI: 10.11569/wcjd.v24.i12.1791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Some endoscopists have reported the usefulness of direct peroral cholangioscopy for the diagnosis and therapy of bile duct lesions. Advantages of direct peroral cholangioscopy (POC) using an ultra-slim endoscope include use of conventional endoscopy equipment, operation by a single endoscopist, and superior image quality of the biliary tree with easy application of enhanced endoscopy and a large working channel. Although ultra-slim endoscopes are usually used for direct peroral cholangioscopy, direct scope insertion is considerably difficult. Moreover, this technique still has some severe complications and limitations. Continuous development of specialized endoscopes and accessories is expected to facilitate the diagnostic and therapeutic roles of direct POC.
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Ishida Y, Itoi T, Okabe Y. Types of Peroral Cholangioscopy: How to Choose the Most Suitable Type of Cholangioscopy. ACTA ACUST UNITED AC 2016; 14:210-9. [PMID: 27053226 DOI: 10.1007/s11938-016-0090-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OPINION STATEMENT A number of case studies have described the usefulness of peroral cholangioscopy for diagnosis and therapy, performed by visualizing the inner cavity of the bile duct. Currently available types of peroral cholangioscopy include peroral videocholangioscopy (POCS) using a mother-baby scope system (MBSS), direct peroral videocholangioscopy (D-POCS), and SpyGlass™ Direct Visualization System (SGDVS). POCS started with cholangioscopy using MBSS, requiring two skilled endoscopists using two endoscopic systems. On the other hand, D-POCS and SGDVS were developed as single-operator techniques. In MBSS, the videocholangioscope is inserted into the bile duct through the accessory channel of a conventional therapeutic duodenoscope. MBSS enables comparatively easy scope insertion into the bile duct and stable scope positioning. POCS using MBSS provides excellent images and can be coupled with an image-enhanced function system. However, it has a smaller accessory channel, limiting the devices that can be used. Additionally, scope fragility is serious problem. D-POCS using an ultraslim upper endoscope has been introduced to overcome the drawback of POCS using MBSS. D-POCS has a larger working channel and requires only one endoscopist. D-POCS allows a greater variety of procedures under excellent imaging even with an image-enhanced function system; however, scope insertion is still challenging. SGDVS is designed for single-operator use and is dedicated to procedural purposes. It comprises a reusable optical probe and disposable delivery catheter, which has four-way deflected steering and dedicated irrigation channels. These features lead to good maneuverability, although image quality is poor due to its optical probe system. All systems' features should be recognized and the appropriate system used depending on the need. Cholangioscopy has shown dramatic progress from diagnosis to therapy with high future growth potential.
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Affiliation(s)
- Yusuke Ishida
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
| | - Yoshinobu Okabe
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
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Korrapati P, Ciolino J, Wani S, Shah J, Watson R, Muthusamy VR, Klapman J, Komanduri S. The efficacy of peroral cholangioscopy for difficult bile duct stones and indeterminate strictures: a systematic review and meta-analysis. Endosc Int Open 2016; 4:E263-75. [PMID: 27004242 PMCID: PMC4798839 DOI: 10.1055/s-0042-100194] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 12/15/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Current evidence supporting the efficacy of peroral cholangioscopy (POC) in the evaluation and management of difficult bile duct stones and indeterminate strictures is limited. The aims of this systematic review and meta-analysis were to assess the following: the efficacy of POC for the therapy of difficult bile duct stones, the diagnostic accuracy of POC for the evaluation of indeterminate biliary strictures, and the overall adverse event rates for POC. PATIENTS AND METHODS Patients referred for the removal of difficult bile duct stones or the evaluation of indeterminate strictures via POC were included. Search terms pertaining to cholangioscopy were used, and articles were selected based on preset inclusion and exclusion criteria. Quality assessment of the studies was completed with a modified Newcastle-Ottawa Scale. After critical literature review, relevant outcomes of interest were analyzed. Meta-regression was performed to examine potential sources of between-study variation. Publication bias was assessed via funnel plots and Egger's test. RESULTS A total of 49 studies were included. The overall estimated stone clearance rate was 88 % (95 % confidence interval [95 %CI] 85 % - 91 %). The accuracy of POC was 89 % (95 %CI 84 % - 93 %) for making a visual diagnosis and and 79 % (95 %CI 74 % - 84 %) for making a histological diagnosis. The estimated overall adverse event rate was 7 % (95 %CI 6 % - 9 %). CONCLUSIONS POC is a safe and effective adjunctive tool with endoscopic retrograde cholangiopancreatography (ERCP) for the evaluation of bile duct strictures and the treatment of bile duct stones when conventional methods have failed. Prospective, controlled clinical trials are needed to further elucidate the precise role of POC during ERCP.
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Affiliation(s)
- Praneet Korrapati
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago Illinois, USA
| | - Jody Ciolino
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago Illinois, USA
| | - Sachin Wani
- Division of Gastroenterology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Janak Shah
- Division of Gastroenterology, California Pacific Medical Center, San Francisco, California, USA
| | - Rabindra Watson
- UCLA Division of Digestive Diseases, Los Angeles, California, USA
| | | | - Jason Klapman
- Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Srinadh Komanduri
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago Illinois, USA,Corresponding author Srinadh Komanduri, MD MS Division of Gastroenterology and HepatologyNorthwestern UniversityFeinberg School of Medicine676 St. Clair St., Suite 14-003Chicago, IL 60611USA+1-312-926-0239
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Lee YN, Moon JH, Choi HJ, Kim HS, Choi MH, Kim DC, Lee TH, Cha SW, Cho YD, Park SH. A newly modified access balloon catheter for direct peroral cholangioscopy by using an ultraslim upper endoscope (with videos). Gastrointest Endosc 2016; 83:240-7. [PMID: 26283272 DOI: 10.1016/j.gie.2015.08.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 08/07/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Direct peroral cholangioscopy (POC) by using an ultraslim upper endoscope has been increasingly applied for diagnosis and treatment of diverse biliary diseases. Recently, an intraductal balloon catheter has been used commonly to guide the flexible ultraslim endoscope. However, accessibility into the bile duct remains a limitation of the procedure. The aim of this study was to evaluate the feasibility and success rate of an intraductal balloon-guided direct POC by using an ultraslim endoscope with a newly modified 5F balloon catheter. METHODS In total, 36 patients with biliary obstruction were included prospectively for a direct POC by using an ultraslim endoscope with a newly modified intraductal 5F balloon catheter. The main outcome measure was technical success, defined as successful advancement of the ultraslim endoscope into the obstructed segment of the biliary tree or the bifurcation. Secondary outcomes were mean time for the total procedure, intubation into the common bile duct and advancement up to the target site after intubation of the ultraslim endoscope, technical success rates of diagnostic and therapeutic interventions, and adverse events. RESULTS The intraductal balloon-guided direct POC using a newly modified 5F balloon catheter was completed successfully in 35 of 36 patients (97.2%). The mean times for total procedure, intubation into the distal common bile duct, and advancement up to the obstructed bile duct segment were 27.3 ± 7.2, 2.2 ± 0.5, and 0.8 ± 0.4 minutes, respectively. In total, 49 interventions were performed in 35 patients, excluding 1 patient in whom we failed to perform direct POC. Technical success of the interventions was achieved with 44 of 49 procedures (89.8%). No adverse events, including cholangitis, were observed. CONCLUSIONS A newly modified 5F balloon catheter seemed to facilitate performing intraductal balloon-guided direct POC for direct visual examination of the bile duct in patients with biliary obstruction. Continued development of endoscopes and accessories are expected to further improve the performance of direct POC.
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Affiliation(s)
- Yun Nah Lee
- Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon and Seoul, Korea
| | - Jong Ho Moon
- Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon and Seoul, Korea
| | - Hyun Jong Choi
- Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon and Seoul, Korea
| | - Hyun Su Kim
- Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon and Seoul, Korea
| | - Moon Han Choi
- Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon and Seoul, Korea
| | - Dong Choon Kim
- Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon and Seoul, Korea
| | - Tae Hoon Lee
- Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon and Seoul, Korea
| | - Sang-Woo Cha
- Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon and Seoul, Korea
| | - Young Deok Cho
- Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon and Seoul, Korea
| | - Sang-Heum Park
- Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon and Seoul, Korea
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12
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Yen HH, Yang CW, Chen YY. Direct cholangioscopy using an ultrathin endoscope for the diagnosis of hemobilia. Dig Endosc 2014; 26:497-8. [PMID: 24666412 DOI: 10.1111/den.12290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Hsu-Heng Yen
- Endoscopy Center, Changhua Christian Hospital, Changhua, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan
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