Diagnostic and therapeutic cholangiopancreatoscopy: performance of a new digital cholangioscope

• Published in: Gastrointestinal endoscopy 2014-06, Vol.79 (6), p.936-942
• Main Authors: Parsi, Mansour A., MD, MPH, Jang, Sunguk, MD, Sanaka, Madhusudhan, MD, Stevens, Tyler, MD, MS, Vargo, John J., MD, MPH
• Format: Article
• Language: English
• Subjects: Bile Duct Diseases - diagnosis; Bile Duct Diseases - therapy; Cholangiopancreatography, Endoscopic Retrograde - instrumentation; Equipment Design; Follow-Up Studies; Gastroenterology and Hepatology; Humans; Image Processing, Computer-Assisted - methods; Narrow Band Imaging - instrumentation; Pancreatic Diseases - diagnosis; Pancreatic Diseases - therapy; Prospective Studies
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2013.10.029

Background High-definition cholangioscopes provide excellent images of the pancreatobiliary ductal system and may play a significant role in diagnosis and treatment of various pancreatobiliary disorders. Objective To assess the performance of a new digital cholangioscope for diagnosis and treatment of pancreatobiliary disorders in clinical practice. Design Prospective study. Setting Academic hospital, tertiary-care referral center. Patients Consecutive patients with suspected pancreatobiliary disorders. Intervention Diagnostic or therapeutic high-definition digital cholangiopancreatoscopy. Main Outcome Measurements Satisfactory visualization of the ductal mucosa and lumen and treatment of pancreatobiliary disorders when indicated. Results A total of 28 cholangioscopy and 4 pancreatoscopy procedures were completed before breakdown of the cholangioscope. Excellent views of the ductal lumen and mucosa were obtained in all patients. In the 18 patients with indeterminate biliary strictures, high-definition cholangioscopy identified all cholangiocarcinomas but labeled as malignant only 1 of 4 strictures caused by pancreatic cancer (sensitivity 73%). All benign strictures were correctly labeled (specificity 100%). Cholangioscopy proved helpful in evaluation of various biliary disorders and lithotripsy of pancreatic stones under direct vision. Limitations Single center, small number of patients. Conclusion High-definition cholangioscopy is a useful adjunct to ERCP in the diagnosis and treatment of pancreatobiliary disorders. Although fragility of the cholangioscope remains a problem, the changes made in the construction of this prototype digital cholangioscope have significantly increased its durability.