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Cholangioscopy and Pancreatoscopy: Their Role in Benign and Malignant Disease

  • Mansour A. ParsiEmail author
Chapter

Abstract

Cholangioscopy and pancreatoscopy involve the insertion of a small-caliber endoscope into the bile duct or the pancreatic duct respectively, allowing direct observation of the ductal walls and lumen, facilitating diagnostic and therapeutic maneuvers such as biopsy and lithotripsy. As an adjunct to ERCP, these procedures are vitally important for evaluating patients with indeterminate biliary or pancreatic duct strictures or fragmentation and removal of ductal stones that cannot be removed by traditional techniques. Although ERCP is the primary method of diagnosing and treating biliary and pancreatic diseases, it nonetheless has several shortcomings that cholangioscopy and pancreatoscopy can help to overcome. ERCP alone does not always differentiate the biological nature of biliary or pancreatic ductal lesions and can fail to determine their intraluminal extension. In addition, ERCP alone provides limited information about mucosal lesions that do not project into the ductal lumen. In such instances, addition of cholangioscopy and pancreatoscopy can provide valuable complementary information that can guide further evaluation and treatment. Once rarely performed, cholangioscopy is moving into mainstream practice and has seen much technological advancement. Although performance of pancreatoscopy is still limited to tertiary care referral centers by expert endoscopists, continuous advancements in flexible endoscopy with development of thinner endoscopes with improved image quality is expected to encourage more widespread use of this procedure. This chapter discusses the technique and current indications for cholangioscopy and pancreatoscopy for diagnostic and therapeutic purposes.

Keywords

Cholangioscopy Pancreatoscopy Choledocholithiasis Bile duct stone Pancreatic stone Chronic pancreatitis Biliary stricture Pancreatic duct stricture Cholangiocarcinoma Pancreatic cancer Indeterminate strictures Biliary disorders Pancreatic disorders 

Supplementary material

Video 4.1

Laser lithotripsy of biliary stones using the Spyglass Digital System. (91,070 kb)

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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Center for Endoscopy and Pancreatobiliary Disorders, Department of Gastroenterology and Hepatology, Digestive Disease InstituteCleveland ClinicClevelandUSA

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