Year 2023 / Volume 115 / Number 11
Letter
Direct peroral cholangioscopy with conventional upper gastrointestinal endoscope

658-659

DOI: 10.17235/reed.2023.9514/2023

Muhammad Ismail, Carlos Noronha Ferreira, Luís Carrilho Ribeiro, Rui Tato Marinho,

Abstract
An 83-year-old male with a history of Whipple procedure (pancreatoduodenectomy) due to pancreatic cancer, underwent endoscopic retrograde colangiopancreatography (ERCP) for acute cholangitis. Because of the altered anatomy, an upper gastrointestinal endoscope was used. Severe stricture of the hepaticojejunal anastomosis was found. The anastomotic stricture was dilated with a 12mm through-the-scope (TTS) balloon under fluoroscopy and direct visualization. Right and left ducts were explored with Dormia basket and balloon, with extraction of bile duct stones and pus. Cholangioscopy with upper gastrointestinal endoscope was performed and residual cholesterol stones were identified in branches of the left hepatic duct and these were removed with the stone extraction balloon under endoscopic visualization. Ciprofloxacin was administered for 5 days and post interventional course was uneventful. Direct peroral colangioscopy using a conventional endoscope provides high quality endoscopic imaging, enabling access to virtual chromoendoscopy and the 2.8 mm diameter working channel allows for interventional procedures. This strategy is useful and economical, helping confirm clearance of common bile duct stones, while allowing extraction of any residual stones. New, cost effective scopes for peroral cholangioscopy are needed to improve the safety and success rate.
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References
1. Moon JH, Choi HJ. The role of direct peroral cholangioscopy using an ultraslim endoscope for biliary lesions: Indications, limitations, and complications. Clin Endosc. 2013;46(5):537-539. doi:10.5946/ce.2013.46.5.537
2. Anderloni A, Auriemma F, Fugazza A, Troncone E, Maia L, Maselli R, et al. Direct peroral cholangioscopy in the management of difficult biliary stones: A new tool to confirm common bile duct clearance. results of a preliminary study. J Gastrointest Liver Dis. 2019;28(1):89-94. doi:10.15403/jgld.2014.1121.281.bil
3. Lee YN, Moon JH, Lee TH, Choi HJ, Itoi T, Beyna T, et al. Prospective Randomized Trial of a New Multibending versus Conventional Ultra-Slim Endoscope for Peroral Cholangioscopy without Device or Endoscope Assistance (with Video). Vol 91. American Society for Gastrointestinal Endoscopy; 2020. doi:10.1016/j.gie.2019.08.007
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Ismail M, Ferreira C, Ribeiro L, Marinho R. Direct peroral cholangioscopy with conventional upper gastrointestinal endoscope . 9514/2023


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Publication history

Received: 06/02/2023

Accepted: 07/02/2023

Online First: 13/02/2023

Published: 13/11/2023

Article Online First time: 7 days

Article editing time: 280 days


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