title: Therapeutic role of direct peroral cholangioscopy using an ultra-slim upper endoscope.
abstract: BACKGROUND
  Peroral cholangioscopy provides direct visualization of the bile duct and facilitates diagnostic procedures and therapeutic intervention. The currently available mother-baby scope system is not widely used because of its disadvantages. Direct peroral cholangioscopy (POC) with a regular, ultra-slim, upper endoscope can provide a valuable and economic solution for evaluating bile duct lesions, although its therapeutic role in biliary tract disease is uncertain. We assessed the usefulness of direct POC with an ultra-slim endoscope for therapeutic application in patients with biliary diseases.
  
  
  METHODS
  Several new techniques and accessories allow therapeutic intervention under direct POC using an ultra-slim upper endoscope with a larger, 2-mm working channel. Intracorporeal laser or electrohydraulic lithotripsy under direct POC is a main therapeutic intervention for patients with bile duct stones resistant to conventional endoscopic procedures. Tumor ablation therapy such as photodynamic therapy and argon plasma coagulation may be performed under direct POC. Direct POC can be applied to guide biliary interventions such as guidewire placement, stone removal, and migrated stent retrieval, using diverse accessories.
  
  
  CONCLUSIONS
  Direct POC with an ultra-slim upper endoscope allows therapeutic intervention for patients with biliary diseases. Enhancements of the endoscope and specialized accessories are expected to expand the therapeutic role of direct POC.
authors.affiliation: Department of Internal Medicine, Soon Chun Hyang University School of Medicine, Bucheon, Korea. jhmoon@schmc.ac.kr
authors.forename: Jong Ho
authors.initials: JH
authors.lastname: Moon
authors.forename: Hyun Jong
authors.initials: HJ
authors.lastname: Choi
authors.forename: Bong Min
authors.initials: BM
authors.lastname: Ko
mesh_terms: D001649:Bile Duct Diseases / Q000175:diagnosis / Q000628:therapy*; D001652:Bile Ducts / Q000473:pathology*; D019723:Endoscopes; D016145:Endoscopy, Digestive System / Q000379:methods*; D004867:Equipment Design; D006801:Humans; D015203:Reproducibility of Results