Diagnostic and therapeutic cholangiopancreatoscopy: performance of a new digital cholangioscope

BackgroundHigh-definition cholangioscopes provide excellent images of the pancreatobiliary ductal system and may play a significant role in diagnosis and treatment of various pancreatobiliary disorders.ObjectiveTo assess the performance of a new digital cholangioscope for diagnosis and treatment of pancreatobiliary disorders in clinical practice.DesignProspective study.SettingAcademic hospital, tertiary-care referral center.PatientsConsecutive patients with suspected pancreatobiliary disorders.InterventionDiagnostic or therapeutic high-definition digital cholangiopancreatoscopy.Main Outcome MeasurementsSatisfactory visualization of the ductal mucosa and lumen and treatment of pancreatobiliary disorders when indicated.ResultsA 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.LimitationsSingle center, small number of patients.ConclusionHigh-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.