2018 Volume 60 Issue 6 Pages 1230-1239
Cholangioscopy can provide endoscopic direct visualization of the biliary system. At present, there are two types of cholangioscopes. One is the mother-baby system and the other is the direct cholangioscope. The mother-baby system requires the presence of two experienced endoscopists because baby cholangioscopes have been shown to be fragile. Recently, single-operator cholangioscopy (SOC) was introduced as the SpyGlass system. Direct cholangioscopy is also a form of single-operator cholangioscopy; however, it requires only one endoscope such as a conventional ultraslim endoscope. Compared with the mother-baby system, the advantages of direct cholangioscopy are the high-resolution images and large-diameter working channel. On the other hand, a disadvantage is the difficulty in inserting the ultraslim scope into the biliary system. For diagnostic purposes, cholangioscopy can be performed for differential diagnosis of benign and malignant lesions, diagnosis of tumor extension, and target biopsy from bile duct mucosa. The main therapeutic indication of cholangioscopy is the treatment of difficult stones. Findings that suggest malignancy are irregular, dilated and tortuous vessels, irregular papillogranular surface, and a nodular, elevated, surface-like submucosal tumor. In contrast, a fine network of thin vessels, flat surface without definite neovascularization, slightly homogeneous papillogranular surface and scale-like appearance without a primary mass are findings that suggest a benign condition.
