Systematic Reviews
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 21, 2015; 21(15): 4722-4734
Published online Apr 21, 2015. doi: 10.3748/wjg.v21.i15.4722
Per oral cholangiopancreatoscopy in pancreatico biliary diseases - Expert consensus statements
Mohan Ramchandani, Duvvur Nageshwar Reddy, Sundeep Lakhtakia, Manu Tandan, Amit Maydeo, Thoguluva Seshadri Chandrashekhar, Ajay Kumar, Randhir Sud, Rungsun Rerknimitr, Dadang Makmun, Christopher Khor
Mohan Ramchandani, Duvvur Nageshwar Reddy, Sundeep Lakhtakia, Manu Tandan, Asian Institute of Gastroenterology, Hyderabad 500082, India
Amit Maydeo, Baldota Institute of Digestive Sciences, Gastroenterology and Endocrinology, Mumbai 400012, India
Thoguluva Seshadri Chandrashekhar, MedIndia Hospitals, Department of Gastroenterology, Chennai 600034, India
Ajay Kumar, Apollo Hospital Delhi, Department of Gastroenterology, Delhi 110076, India
Randhir Sud, Medanta, Gastroenterology and Hepatology, Gurgaon 122001, India
Rungsun Rerknimitr, King Chulalongkorn Memorial Hospital, Department of Medicine, Pathumwan 10330, Bangkok, Thailand
Dadang Makmun, Cipto Mangunkusumo Hospital, Department of Internal Medicine, Faculty of Medicine, Jakarta 10430, Indonesia
Christopher Khor, National University Hospital, Department of Gastroenterology and Hepatology, Singapore 119074, Singapore
Author contributions: Ramchandani M, Reddy DN, Lakhtakia S, Tandan M, Maydeo A, Chandrashekhar TS, Kumar A, Sud R, Rerknimitr R, Makmun D and Khor C participated and contributed equally to the face-to-face meeting of the consensus workgroup; Ramchandani M wrote the paper; Reddy DN, Lakhtakia S, Tandan M, Maydeo A, Chandrashekhar TS, Kumar A, Sud R, Rerknimitr R, Makmun D and Khor C reviewed and contributed to the paper.
Data sharing: No original data was used or reported in this paper. Only previously published data were reported in this consensus statement paper. No consent was obtained as no original data has been collected in preparation of this paper.
Conflict-of-interest: None of the authors have a conflict of interest as it pertains to this paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Duvvur Nageshwar Reddy, MD, DM, DSc, FAMS, FRCP, FASGE, FACG, MWGO, Chairman and Chief of Gastroenterology, Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad 500082, India. aigindia@yahoo.co.in
Telephone: +91-40-23378888 Fax: +91-40-23324255
Received: July 18, 2014
Peer-review started: July 18, 2014
First decision: October 14, 2014
Revised: November 19, 2014
Accepted: January 21, 2015
Article in press: January 21, 2015
Published online: April 21, 2015
Processing time: 276 Days and 13.6 Hours
Abstract

AIM: To provide consensus statements on the use of per-oral cholangiopancreatoscopy (POCPS).

METHODS: A workgroup of experts in endoscopic retrograde cholangiopancreatography (ERCP), endosonography, and POCPS generated consensus statements summarizing the utility of POCPS in pancreaticobiliary disease. Recommendation grades used validated evidence ratings of publications from an extensive literature review.

RESULTS: Six consensus statements were generated: (1) POCPS is now an important additional tool during ERCP; (2) in patients with indeterminate biliary strictures, POCS and POCS-guided targeted biopsy are useful for establishing a definitive diagnosis; (3) POCS and POCS-guided lithotripsy are recommended for treatment of difficult common bile duct stones when standard techniques fail; (4) in patients with main duct intraductal papillary mucinous neoplasms (IPMN) POPS may be used to assess extent of tumor to assist surgical resection; (5) in difficult pancreatic ductal stones, POPS-guided lithotripsy may be useful in fragmentation and extraction of stones; and (6) additional indications for POCPS include selective guidewire placement, unexplained hemobilia, assessing intraductal biliary ablation therapy, and extracting migrated stents.

CONCLUSION: POCPS is important in association with ERCP, particularly for diagnosis of indeterminate biliary strictures and for intra-ductal lithotripsy when other techniques failed, and may be useful for pre-operative assessment of extent of main duct IPMN, for extraction of difficult pancreatic stones, and for unusual indications involving selective guidewire placement, assessing unexplained hemobilia or intraductal biliary ablation therapy, and extracting migrated stents.

Keywords: Per oral cholangiopancreatoscopy; Intraductal lithotripsy; Indeterninate biliary strictures; Cholangioscopy; Pancreatoscopy

Core tip: Per-oral cholangiopancreatoscopy (POCPS) is now an important additional tool during endoscopic retrograde cholangiopancreatography. In patients with indeterminate biliary strictures, peroral cholangioscopy (POCS) and POCS-guided targeted biopsy are useful for establishing a definitive diagnosis. POCS and POCS-guided lithotripsy are recommended for treatment of difficult common bile duct stones when standard techniques fail. In patients with main duct intraductal papillary mucinous neoplasms POPS may be used to assess extent of tumor to assist surgical resection. In difficult pancreatic ductal stones, POPS-guided lithotripsy may be useful in fragmentation and extraction of stones. Additional indications for POCPS include selective guidewire placement, unexplained hemobilia, assessing intraductal biliary ablation therapy, and extracting migrated stents.