Intraductal biliary and pancreatic endoscopy: an expanding scope of possibility.
Intraductal endoscopy describes the use of an endoscope to directly visualize the biliary and pancreatic ducts. For many years, technological challenges have made performing these procedures difficult. The "mother-baby" system and other various miniscopes have been developed, but routine use has been hampered due to complex setup, scope fragility and the time consuming, technically demanding nature of the procedure. Recently, the SpyGlass peroral cholangiopancreatoscopy system has shown early success at providing diagnostic information and therapeutic options. The clinical utility of intraductal endoscopy is broad. It allows better differentiation between benign and malignant processes by allowing direct visualization and targeted sampling of tissue. Therapeutic interventions, such as electrohydraulic lithotripsy (EHL), laser lithotripsy, photodynamic therapy, and argon plasma coagulation (APC), may also be performed as part of intraductal endoscopy. Intraductal endoscopy significantly increases the diagnostic and therapeutic yield of standard endoscopic retrograde cholangiography (ERCP), and as technology progresses, it is likely that its utilization will only increase. In this review of intraductal endoscopy, we describe in detail the various endoscopic platforms and their diagnostic and clinical applications.
Judah
Joel R
JR
Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida 32610-0214, United States.
Draganov
Peter V
PV
D001652:Bile Ducts / Q000473:pathology*; D001660:Biliary Tract Diseases / Q000473:pathology* / Q000628:therapy; D002760:Cholangiopancreatography, Endoscopic Retrograde; D020776:Endoscopes, Gastrointestinal; D016145:Endoscopy, Digestive System / Q000009:adverse effects / Q000266:history / Q000295:instrumentation / Q000379:methods; D004867:Equipment Design; D049673:History, 20th Century; D006801:Humans; D010182:Pancreatic Diseases / Q000473:pathology* / Q000628:therapy; D010183:Pancreatic Ducts / Q000473:pathology*; D011237:Predictive Value of Tests; D016896:Treatment Outcome