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• W1984358680 abstract "Dedicated cholangioscopes provide poor images, are expensive, fragile, difficult to use, and offer weak irrigation, and tiny accessory channels. To overcome these limitations, we have developed experience with techniques allowing cholangioscopy via an ultrathin 5.9 mm gastroscope (UTG), (GIF XP-160, Olympus) or an 8.6 mm diagnostic gastroscope (DG), (GIF-160, Olympus). These techniques include overtube use to prevent UTG looping, a maneuver for free scope insertion into the distal CBD similar to colonoscopic IC valve intubation, followed by deep CBD insertion, assisted if necessary by traction via balloons inflated in the proximal biliary tree (20 mm balloon for DG, 10 mm for UTG), or biliary forceps traction (UTG). We present our experience with UTG/DG cholangioscopy as part of a systematic protocol that utilizes an “as big as fits” approach to cholangioscope selection. From 6/1/09 to 11/30/10 consecutive non-pregnant patients, able to consent, undergoing ERCP, and requiring cholangioscopy enrolled: Spyglass was used if CBD was ≤7 mm on fluoroscopy, UTG if CBD >7 and <12 mm and DG if CBD ≥12 mm. We present our data on UTG/DG cholangioscopy performed as part of this “as big as fits” protocol. 500 ERCPs. 53 required cholangioscopy. Spyglass 18, UTG 9, DG 26. UTG/DG cases: Age 74 (33-103), 34% male. Choledocholithiasis (80%), abnormal imaging (11%), CBD lesion (6%), CBD stricture (3%). Mean CBD 14.7 mm (7.5-28). Sphincteroplasty in 77%, size 13.1 mm, (10-18). Overtube used in 26% (6/9 UTG, 3/26 DG), balloon traction in 49% (1/9 UTG, 16/26 DG), forceps traction in 6% (2/9 UTG, 0/26 DG), no assistive devices in 26% (2/9 UTG, 7/26 DG). Insertion time from mouth to desired CBD level, 9 min (4-24). Deep insertion (confluence/intrahepatics) achieved in 80%. Success (cholangioscopy goal achieved) in 83%. Stone lithotripsy/extraction (22%), biopsy (14%), none (cholangioscopy confirmed ductal clearance) 51%. 7 adverse events (AEs):1 non-embolic CVA, pt recovered, 4 sphincterotomy bleeds, 2 self-limited AEs due to cholangioscopy (6%), (1 hemobilia, 1 microperforation, due to inflation of the 20 mm balloon in biliary radicle). No significant UTG and DG difference in insertion time and depth, and success. Trend for more complications with DG (UTG 11%, DG 23%, p =0.6478). A systematic, “as big as fits” protocol for cholangioscope selection resulted in use of a UTG or DG in 2/3 of cases. Gastroscopes provided superior imaging, superior irrigation, and a large accessory channel allowing a broad spectrum of biliary interventions including large biopsies, EMR, EHL and capture of multiple stones with Roth nets Direct peroral cholangioscopy with gastroscopes is a highly efficient, safe, and successful technique for patients with distal CBD>7 mm.View Large Image Figure ViewerDownload Hi-res image Download (PPT)" @default.
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• W1984358680 date "2011-04-01" @default.
• W1984358680 modified "2023-09-23" @default.
• W1984358680 title "84 Prospective Evaluation of a Protocol for Direct PerOral Cholangioscopy Using Gastroscopes. An “As Big As Fits” Approach to Cholangioscope Selection" @default.
• W1984358680 doi "https://doi.org/10.1016/j.gie.2011.03.012" @default.
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