Intraductal biliary and pancreatic endoscopy: An expanding scope of possibility

Table 1 Diagnostic uses of intraductal endoscopy

Optically guided biopsies of stricture

Indeterminate stricture

Dominant stricture in primary sclerosing cholangitis

Evaluate fixed filling defect noted on cholangiogram or other imaging

Differentiate benign versus malignant intraductal mass

Optical examination yields visual clues

Improved yield from tissue sampling under visual guidance

Precisely map intraductal tumor prior to resection

Collect significant fluid sample for cytology

Visually evaluate intraductal mucinous neoplasms

Visually evaluate choledochal cyst

Visually evaluate for post-liver transplant ductal ischemia

Visually evaluate for intraductal spread of ampullary adenoma

Evaluate with visual exam and tissue sampling for infection

Cytomegalovirus

Fungal infection

Table 2 Current therapeutic applications of intraductal endoscopy

Stone extraction

Electrohydraulic lithotripsy (EHL)

Laser lithotripsy

Argon plasma coagulation (APC)

Photodynamic therapy

Nd-YAG laser ablation

Cystic duct stent placement