title: Direct transnasal cholangioscopy with ultraslim endoscopes: a one-step intraductal balloon-guided approach.
abstract: BACKGROUND
  Direct cholangioscopy using an ultraslim endoscope is an attractive alternative to the conventional mother-baby endoscope system because it provides a single-operator platform and high-resolution image quality and allows advanced therapeutic interventions. However, biliary access is cumbersome and usually requires previous guidewire placement via retrograde cholangiography.
  
  
  OBJECTIVE
  To evaluate the feasibility of a 1-step transnasal cholangioscopy (TNC) technique using an ultraslim endoscope with an intraductal balloon to maintain access without previous guidewire placement.
  
  
  METHODS
  Prospective, observational clinical feasibility study.
  
  
  METHODS
  Single tertiary referral center.
  
  
  METHODS
  Overall procedure success rates and complications. A successful procedure was defined as one in which the endoscope was advanced into the bifurcation or stenotic segment of the biliary system.
  
  
  METHODS
  Twenty-five patients with biliary disease and previous sphincterotomy underwent direct TNC.
  
  
  RESULTS
  TNC was successful in 18 of the 25 patients (72%). The procedure revealed 3 common bile duct stones, 4 benign biliary strictures, 1 intraductal adenoma, and 3 cholangiocarcinomas. Eight patients underwent forceps biopsies under direct visualization, and 7 patients underwent therapeutic interventions, including argon plasma coagulation (n = 2), laser lithotripsy (n = 1), stent (n = 1), and stone extraction (n = 3). Other than 1 patient with procedure-related cholangitis, no complications were observed.
  
  
  CONCLUSIONS
  Small number of patients and no comparison with conventional cholangioscopy.
  
  
  CONCLUSIONS
  One-step TNC with an ultraslim endoscope allows direct visual examination and therapeutic intervention in the bile ducts in the majority of patients with biliary disease. However, development of further accessory instruments will be needed to improve the success rate.
authors.affiliation: Department of Internal Medicine II, Dr. Horst Schmidt Kliniken (Medical School of the University of Mainz), Wiesbaden, Germany. pohljuergen@web.de
authors.forename: Jürgen
authors.initials: J
authors.lastname: Pohl
authors.forename: Christian
authors.initials: C
authors.lastname: Ell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001649:Bile Duct Diseases / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D001706:Biopsy; D002404:Catheterization; D016145:Endoscopy, Digestive System / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies