Carbon dioxide insufflation is useful for obtaining clear images of the bile duct during peroral cholangioscopy (with video)

BackgroundPeroral cholangioscopy (POCS) is useful for the diagnosis of various bile duct lesions. However, it is often difficult to obtain clear images because of bile or biliary sludge in the bile duct, even after vigorous irrigation of the bile duct with saline solution. Therefore, this study investigated whether inflation with carbon dioxide (CO2) yields clearer images of the bile duct than conventional saline solution irrigation during POCS.ObjectiveTo evaluate the clinical utility and safety of CO2 insufflation into the bile duct to obtain clear images in POCS observations by comparing this method with conventional saline solution irrigation.SettingA single center.DesignCase-control study.PatientsNineteen patients with suspected biliary diseases.InterventionsCO2 insufflation into the bile duct during POCS.Main Outcome MeasurementsThe quality and safety of this method.ResultThe quality of the images of the bile duct lumen with CO2 insufflation (10 patients) was significantly superior to those with saline solution irrigation (9 patients) in both clarity (P < .05) and color (P < .05). In particular, extremely clear images could be obtained from the middle part of common bile duct to the right and left hepatic duct. No serious POCS-related complications occurred. There was no significant change in the venous partial pressure of the CO2 level during the procedure.LimitationsThe number of patients examined was small.ConclusionsCO2 insufflation is useful for obtaining clear images of the bile duct during POCS, which makes it possible to determine the qualitative diagnosis and the extent of various bile duct lesions.