Diagnostic and therapeutic biliary endoscopy in a new era

Abstract

Innovations over around the last 15 years in ERCP related procedures are 1) 0.025 inch guidewire, 2) Balloon enteroscopy-assisted ERCP for altered anatomy, 3) EPLBD for difficult to treat bile duct stones, 4) disposable peroral digital cholangioscope, 5) disposable duodenoscope, and so on. And innovations in EUS related procedures are 1) EUS-FNA, 2) EUS-guided biliary drainage, 3) lumen-apposing metal stent, and so on. Remaining issues in biliary endoscopy which should be resolved in a new era are 1) approval of biliary endoscopic procedures to be covered by insurance and reimbursement of devices, 2) reduction of X-ray exposure, 3) prevention of post-ERCP pancreatitis, 4) 100% selective biliary cannulation, 5) improvement of diagnostic accuracy on endoscopic tissue acquisition for biliary stricture, 6) improvement of patency in biliary stents, 7) artificial intelligence based image diagnosis in biliary endoscopy, 8) standardization of interventional EUS procedures.