Clinical experience with peroral cholangiopancreatoscopy (PCPS) under duodenoscopic guidance

Abstract

Peroral cholangiopancreatoscopy (PCPS) under duodenoscopic guidance was attempted on 18 patients with biliary tract and pancreatic diseases. A side-viewing duodenoscope (masterscope) and three types of cholangiopancreatoscopes (subscope) passed through an an instrument channel of the masterscope which were all specially made by Olympus Optical Co. were used in this study. The procedure was successfully accomplished on 15 of 18 patients without any complications; cholangioscopy in four, pancreatoscopy in three and cholangiopancreatoscopy in eight. In the remaining three, the tip of the subscopes could not be introduced into the duct systems because of technical or anatomical difficulty for cannulation of the ampulla of Vater.
1) Peroral cholangioscopy (PCS)
Cholangioscopy was successful overall in 12 of 18 patients. Of these 12 patients, inspection of the hepatic biliary tree as well as the extrahepatic duct was possible in 8 patients. In the remaining four, the examination was limited within the extrahepatic biliary tract. The mucosa of the duct was shown to be yellow through bile. The bifurcation of the common hepatic duct was readily recognized as a carina similar to the bronchial bifurcation, and the hepatic duct shortly divided into two segmental divisions. In patients with choledocholithiasis, calculi were clearly visualized.
2) Peroral pancreatoscopy (PPS)
PPS was successfully accomplished on 11 of 18 patients; two with visualization of the entire main duct and nine with that of the head and body. The lumen of the pancreatic duct had a pale-pinkish appearance with a delicate submucosal vascular reticulum. The orifices of the branch ducts sometimes could be recognized as pinholes.