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• W2807314441 abstract "Peroral cholangioscopy has been reported since the 1970s, but mother-daughter and single-operator scopes have limitations, restricting widespread use. Despite advances with Spyglass DS, scopes are still fragile, expensive, with small accessory channels and somewhat limited views. There is increasing interest in techniques using thin gastroscopes for direct cholangioscopy. We describe our protocol for cholangioscope selection and techniques to assist with scope insertion into the proximal bile duct via a maneuver for free hand scope insertion. To facilitate insertion, overtubes can be used to prevent looping and/or balloon or forceps for traction assistance. From 6/1/09 to 12/31/13 consecutive patients undergoing ERCP with cholangioscopy were enrolled. Endoscopes used: Ultrathin 5.9 mm gastroscope (UTG), (GIF XP-160, Olympus); 8.6 mm diagnostic gastroscope (DG), (GIF-160, Olympus). UTG was used if the CBD was >7 and <12 mm and DG was used if the CBD ≥12 mm on fluoroscopy. 940 ERCPs were performed by an experienced operator. 79 required cholangioscopy with gastroscopes: UTG 40, DG 38. Mean age 73 (22-103), 33% male. Indications: choledocholithiasis (77%), evaluation of lesion or stricture (9%), abnormal imaging (6%), EHL with stone extraction (6%), assess ductal injury (1%). Mean CBD: UTG 10.9 mm (7-22), DG 16.6 (12-28). Sphincteroplasty was performed in 82.2%, size 12.3 (10-18). An overtube was used in 12.7% (UTG 6, DG 4), balloon traction in 54.4% (UTG 22, DG 21), no assistive device in 31.2% (UTG 12, DG 13), overtube and balloon in 1.2% (UTG 1, DG 0). Insertion time to desired CBD level was 12.5 min (3-35). Deep insertion (confluence/intrahepatics) was achieved in 88.4%. Success was achieved in 87.1%. Interventions: stone/lithotripsy/extraction 23.4%, biopsy 9%, stricture dilation with stone extraction (2.6%), EMR (1.3%), hemostasis (1.3%), none (cholangioscopy confirmed ductal clearance/no lesion) 55.1%, failed cholangioscopy goal (7.7%). 12 adverse events (AEs): 1 non-embolic ischemic CVA (patient recovered), 9 sphincterotomy bleeds, 2 self limited AEs due to cholangioscopy (1 hemobilia, 1 microperforation due to inflation of balloon in biliary radicle). No significant difference between gastroscopes in insertion time and depth, and success. More AEs were seen with the DG (UTG 3.8%, DG 11.5%, p = 0.0485). Gastroscopes for dedicated cholangioscopy offer superior imaging and irrigation with large accessory channels that permit a wide variety of interventions including large biopsies, EMR, EHL, and large stone extraction. A systematic protocol for cholangioscope selection allows for an efficient, safe and successful technique in bile ducts >7 mm. However, due to a trend in AEs with the larger diameter DG, we now favor the UTG even for larger ducts if a large accessory channel is not required.View Large Image Figure ViewerDownload Hi-res image Download (PPT)" @default.
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• W2807314441 date "2018-06-01" @default.
• W2807314441 modified "2023-09-25" @default.
• W2807314441 title "Sa1287 PERORAL CHOLANGIOSCOPY WITH GASTROSCOPES: SEE MORE, DO MORE!" @default.
• W2807314441 doi "https://doi.org/10.1016/j.gie.2018.04.1438" @default.
• W2807314441 hasPublicationYear "2018" @default.
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