Current status and novel development of peroral cholangioscopy

Abstract

Pancreatobiliary endoscopy is often performed with fluoroscopy, which means it is like IVR that employs an endoscopy as a sheath. Peroral cholangioscopy (POCS) is one of the modalities which enable us to observe biliary tract lumen. Three techniques have ever been reported, which are single operator cholangioscopy (SOC), dual operator cholangioscopy (DOC), and direct cholangioscopy (DC). SOC and DOC employ a mother-baby style. DOC needs two operators and the scope has excellent view, but it is fragile and has unfavorable maneuverability. SOC can be performed with a disposable cholangioscopy under a single operator. The scope has a good maneuverability, but image quality is inferior to that of DOC. DC is usually performed with an ultraslim gastroscope. The scope has a larger CCD and channels than those of baby scopes. However, DC is an unstable technique and has a rare but severe complication such as air embolism. Technical innovation is necessary to advance development of POCS.