title: Endoscopic direct cholangioscopy by using an ultra-slim upper endoscope: a feasibility study.
abstract: BACKGROUND
  The search for an easier and less cumbersome technique to perform direct visual examination of the biliary tree is still underway.
  
  
  OBJECTIVE
  To assess the feasibility of performing endoscopic direct cholangioscopy utilizing an ultra-slim upper endoscope designed for pediatric patients.
  
  
  METHODS
  Prospective, observational, pilot study.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Three patients who underwent endoscopic retrograde cholangiography for evaluation and treatment of choledocholithiasis.
  
  
  METHODS
  Following the completion of the endoscopic retrograde cholangiography, a 0.035-inch diameter super-stiff Jagwire (Boston Scientific Corp, Natick, Mass) was placed in the common bile duct. Using the wire to maintain access, we removed the duodenoscope and backloaded the wire onto an ultra-slim upper endoscope (GIF-XP 160, Olympus America Inc, Melville, NY), which was advanced over the guidewire under fluoroscopic and endoscopic control into the duodenum and then across the ampulla of Vater into the common bile duct and upstream.
  
  
  RESULTS
  Endoscopic direct cholangioscopy was attempted and successfully completed in all 3 patients. One patient was found to have persistent large amount of sludge and stones, and was referred for surgery. In the other two patients, endoscopic direct cholangioscopy demonstrated complete duct clearance, obviating the need for stent placement and repeat endoscopic retrograde cholangiography procedures.
  
  
  CONCLUSIONS
  Small sample size, pilot study.
  
  
  CONCLUSIONS
  Endoscopic direct cholangioscopy with an ultra-slim upper endoscope originally designed for pediatric use is feasible. Future advances in endoscope development, as well as specifically designed accessories, could lead to the next generation of intraductal diagnosis and therapy.
authors.affiliation: Section of Endoscopy and Therapeutics, and the Cancer Research Center, The University of Chicago, Chicago, Illinois 60637, USA.
authors.forename: Alberto
authors.initials: A
authors.lastname: Larghi
authors.forename: Irving
authors.initials: I
authors.lastname: Waxman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D042883:Choledocholithiasis / Q000175:diagnosis / Q000628:therapy*; D020776:Endoscopes, Gastrointestinal; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D010865:Pilot Projects; D011446:Prospective Studies