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World J Gastrointest Endosc. May 16, 2015; 7(5): 510-517
Published online May 16, 2015. doi: 10.4253/wjge.v7.i5.510
Current status of peroral cholangioscopy in biliary tract diseases
Stefania Ghersi, Lorenzo Fuccio, Marco Bassi, Carlo Fabbri, Vincenzo Cennamo
Stefania Ghersi, Marco Bassi, Carlo Fabbri, Vincenzo Cennamo, Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna, Bellaria-Maggiore Hospital, 40133 Bologna, Italy
Lorenzo Fuccio, Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy
Author contributions: Ghersi S and Cennamo V contributed equally to this manuscript; all the authors contributed to the writing and approved the final version.
Conflict-of-interest: None.
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: Stefania Ghersi, MD, Unit of Gastroenterology and Digestive Enoscopy, AUSL Bologna, Bellaria-Maggiore Hospital, Largo Nigrisoli 2, 40133 Bologna, Italy. stefania.ghersi@ausl.bo.it
Telephone: +39-51-6478282 Fax:+39-51-6478145
Received: November 17, 2014
Peer-review started: November 17, 2014
First decision: December 12, 2014
Revised: January 16, 2015
Accepted: February 9, 2015
Article in press: February 11, 2015
Published online: May 16, 2015
Processing time: 182 Days and 1.6 Hours
Abstract

Peroral cholangioscopy (POC) is an important tool for the management of a selected group of biliary diseases. Because of its direct visualization, POC allows targeted diagnostic and therapeutic procedures. POC can be performed using a dedicated cholangioscope that is advanced through the accessory channel of a duodenoscope or via the insertion of a small-diameter endoscope directly into the bile duct. POC was first described in the 1970s, but the use of earlier generation devices was substantially limited by the cumbersome equipment setup and high repair costs. For nearly ten years, several technical improvements, including the single-operator system, high-quality images, the development of dedicated accessories and the increased size of the working channel, have led to increased diagnostic accuracy, thus assisting in the differentiation of benign and malignant intraductal lesions, targeting biopsies and the precise delineation of intraductal tumor spread before surgery. Furthermore, lithotripsy of difficult bile duct stones, ablative therapies for biliary malignancies and direct biliary drainage can be performed under POC control. Recent developments of new types of conventional POCs allow feasible, safe and effective procedures at reasonable costs. In the current review, we provide an updated overview of POC, focusing our attention on the main current clinical applications and on areas for future research.

Keywords: Peroral cholangioscopy; Biliary tract disease; Direct visualization; Indeterminate biliary strictures; Bile duct stones

Core tip: Peroral cholangioscopy is a rapidly developing endoscopic technique that provides the possibility to directly explore the bile duct, thereby increasing diagnostic accuracy in selected cases. Less expensive and safer than in the past, the field of applications of peroral cholangioscopy, through the development of new dedicated accessories, has been recently expanded and includes several therapeutic options such as the lithotripsy of difficult bile duct stones, ablative therapies for biliary malignancies and direct biliary drainage.