Enrique Pérez-Cuadrado-Robles1, Pierre H Deprez2. 1. Department of Hepato-Gastroenterology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium. 2. Department of Hepato-Gastroenterology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium. pdeprez@uclouvain.be.
Abstract
PURPOSE OF REVIEW: Direct endoscopic visualization of the biliary and pancreatic ducts by single-operator cholangioscopy (SOC) and pancreatoscopy (SOP) is an expanding technique with an increasing number of indications. This review provides technical tips and tricks and a literature update on the usefulness of SOC and SOP in clinical practice. RECENT FINDINGS: SOC has shown a 91.3% and 87.3% diagnostic procedural success in indeterminate strictures and difficult stones respectively, with a 9.4%-16.4% complication rate. Although the interpretation of the images suspected for malignancy can be challenging, new classifications based in mucosal and vascular patterns as well as better devices are in development. A higher sensitivity has been associated to targeted biopsies, compared to brushing and blinded biopsies. Indeed, SOC has recently demonstrated a decrease in the number of procedures and costs when compared with endoscopic retrograde cholangiopancreatography. This technique has also been reported for many other diagnostic and therapeutic indications, such as cholangiocarcinoma staging and foreign body extraction. Similarly, diagnostic and therapeutic SOP in indeterminate strictures or pancreatic stones, and intraductal papillary mucinous neoplasms, has been successfully reported. Research to date supports the use of cholangioscopy as a complementary examination in patients with indeterminate strictures, difficult stones and specific situations. In a near future, there will probably be new established indications, a better understanding of the imaging findings and a place of SOC/SOP as first line in selected scenarios.
PURPOSE OF REVIEW: Direct endoscopic visualization of the biliary and pancreatic ducts by single-operator cholangioscopy (SOC) and pancreatoscopy (SOP) is an expanding technique with an increasing number of indications. This review provides technical tips and tricks and a literature update on the usefulness of SOC and SOP in clinical practice. RECENT FINDINGS: SOC has shown a 91.3% and 87.3% diagnostic procedural success in indeterminate strictures and difficult stones respectively, with a 9.4%-16.4% complication rate. Although the interpretation of the images suspected for malignancy can be challenging, new classifications based in mucosal and vascular patterns as well as better devices are in development. A higher sensitivity has been associated to targeted biopsies, compared to brushing and blinded biopsies. Indeed, SOC has recently demonstrated a decrease in the number of procedures and costs when compared with endoscopic retrograde cholangiopancreatography. This technique has also been reported for many other diagnostic and therapeutic indications, such as cholangiocarcinoma staging and foreign body extraction. Similarly, diagnostic and therapeutic SOP in indeterminate strictures or pancreatic stones, and intraductal papillary mucinous neoplasms, has been successfully reported. Research to date supports the use of cholangioscopy as a complementary examination in patients with indeterminate strictures, difficult stones and specific situations. In a near future, there will probably be new established indications, a better understanding of the imaging findings and a place of SOC/SOP as first line in selected scenarios.
Authors: B Sun; J H Moon; Q Cai; R Rerknimitr; S Ma; S Lakhtakia; S Ryozawa; H Kutsumi; I Yasuda; H Shiomi; X Li; W Li; X Zhang; T Itoi; H-P Wang; D Qian; J Y Wong Lau; Z Yang; M Ji; B Hu Journal: Aliment Pharmacol Ther Date: 2018-06-07 Impact factor: 8.171
Authors: Olaya I Brewer Gutierrez; Noor L H Bekkali; Isaac Raijman; Richard Sturgess; Divyesh V Sejpal; Hanaa D Aridi; Stuart Sherman; Raj J Shah; Richard S Kwon; James L Buxbaum; Claudio Zulli; Wahid Wassef; Douglas G Adler; Vladimir Kushnir; Andrew Y Wang; Kumar Krishnan; Vivek Kaul; Demetrios Tzimas; Christopher J DiMaio; Sammy Ho; Bret Petersen; Jong Ho Moon; B Joseph Elmunzer; George J M Webster; Yen-I Chen; Laura K Dwyer; Summant Inamdar; Vanessa B Patrick; Augustin Attwell; Amy Hosmer; Christopher Ko; Attilio Maurano; Avik Sarkar; Linda J Taylor; Martin H Gregory; Daniel S Strand; Ali Raza; Shivangi Kothari; Jessica P Harris; Nikhil A Kumta; Amar Manvar; Mark D Topazian; Yun Nah Lee; Clayton M Spiceland; Arvind J Trindade; Majidah A Bukhari; Omid Sanaei; Saowanee Ngamruengphong; Mouen A Khashab Journal: Clin Gastroenterol Hepatol Date: 2017-10-24 Impact factor: 11.382