BACKGROUND: The "mother-baby" endoscope system currently used for peroral cholangioscopy (POC) has several limitations. Endoscopic direct cholangioscopy when using an ultra-slim upper endoscope with a guidewire to maintain access has been reported, but appropriate accessories are required to increase the success rate. Herein, we describe a novel method, overtube-balloon-assisted endoscopy, for direct POC. OBJECTIVE: To evaluate the feasibility and usefulness of direct POC when using an ultra-slim upper endoscope with an overtube balloon to maintain access. SETTING: A single center. DESIGN: Case series. PATIENTS: Twelve patients with biliary disease. INTERVENTIONS: Direct POC by using an ultra-slim upper endoscope and diagnostic and/or therapeutic procedures. MAIN OUTCOME MEASUREMENTS: Success rate of this technique, diagnostic or therapeutic feasibility, and complications. RESULTS: Overtube-balloon-assisted direct POC was performed successfully in 10 of 12 patients (83.3%). The procedure revealed 4 common bile duct (CBD) stones, 4 benign biliary strictures, 1 polypoid tumor, and 1 cholangiocarcinoma. Five patients underwent forceps biopsy under direct visualization of the intraductal lesion. Laser lithotripsy was successfully performed in 1 patient. No procedure-related complication occurred. LIMITATIONS: A small number of patients and no comparison with conventional cholangioscopy. CONCLUSIONS: The overtube balloon appears to be a useful accessory in direct POC when using an ultra-slim upper endoscope. However, further development of a slim overtube or other accessories is necessary to improve the success rate of direct POC.
BACKGROUND: The "mother-baby" endoscope system currently used for peroral cholangioscopy (POC) has several limitations. Endoscopic direct cholangioscopy when using an ultra-slim upper endoscope with a guidewire to maintain access has been reported, but appropriate accessories are required to increase the success rate. Herein, we describe a novel method, overtube-balloon-assisted endoscopy, for direct POC. OBJECTIVE: To evaluate the feasibility and usefulness of direct POC when using an ultra-slim upper endoscope with an overtube balloon to maintain access. SETTING: A single center. DESIGN: Case series. PATIENTS: Twelve patients with biliary disease. INTERVENTIONS: Direct POC by using an ultra-slim upper endoscope and diagnostic and/or therapeutic procedures. MAIN OUTCOME MEASUREMENTS: Success rate of this technique, diagnostic or therapeutic feasibility, and complications. RESULTS: Overtube-balloon-assisted direct POC was performed successfully in 10 of 12 patients (83.3%). The procedure revealed 4 common bile duct (CBD) stones, 4 benign biliary strictures, 1 polypoid tumor, and 1 cholangiocarcinoma. Five patients underwent forceps biopsy under direct visualization of the intraductal lesion. Laser lithotripsy was successfully performed in 1 patient. No procedure-related complication occurred. LIMITATIONS: A small number of patients and no comparison with conventional cholangioscopy. CONCLUSIONS: The overtube balloon appears to be a useful accessory in direct POC when using an ultra-slim upper endoscope. However, further development of a slim overtube or other accessories is necessary to improve the success rate of direct POC.