Overtube-balloon-assisted direct peroral cholangioscopy by using an ultra-slim upper endoscope (with videos).
BACKGROUND
The "mother-baby" endoscope system currently used for peroral cholangioscopy (POC) has several limitations. Endoscopic direct cholangioscopy when using an ultra-slim upper endoscope with a guidewire to maintain access has been reported, but appropriate accessories are required to increase the success rate. Herein, we describe a novel method, overtube-balloon-assisted endoscopy, for direct POC.


OBJECTIVE
To evaluate the feasibility and usefulness of direct POC when using an ultra-slim upper endoscope with an overtube balloon to maintain access.


METHODS
A single center.


METHODS
Case series.


METHODS
Twelve patients with biliary disease.


METHODS
Direct POC by using an ultra-slim upper endoscope and diagnostic and/or therapeutic procedures.


METHODS
Success rate of this technique, diagnostic or therapeutic feasibility, and complications.


RESULTS
Overtube-balloon-assisted direct POC was performed successfully in 10 of 12 patients (83.3%). The procedure revealed 4 common bile duct (CBD) stones, 4 benign biliary strictures, 1 polypoid tumor, and 1 cholangiocarcinoma. Five patients underwent forceps biopsy under direct visualization of the intraductal lesion. Laser lithotripsy was successfully performed in 1 patient. No procedure-related complication occurred.


CONCLUSIONS
A small number of patients and no comparison with conventional cholangioscopy.


CONCLUSIONS
The overtube balloon appears to be a useful accessory in direct POC when using an ultra-slim upper endoscope. However, further development of a slim overtube or other accessories is necessary to improve the success rate of direct POC.
Choi
Hyun Jong
HJ
Department of Internal Medicine, Digestive Disease Center, Soon Chun Hyang University School of Medicine, Bucheon and Seoul, Korea.
Moon
Jong Ho
JH
Ko
Bong Min
BM
Hong
Su Jin
SJ
Koo
Hyun Cheol
HC
Cheon
Young Koog
YK
Cho
Young Deok
YD
Lee
Joon Seong
JS
Lee
Moon Sung
MS
Shim
Chan Sup
CS