title: Clinical application of a single-operator direct visualization system improves the diagnostic and therapeutic yield of endoscopic retrograde cholangiopancreatography.
abstract: BACKGROUND
  Single-operator cholangioscopy enables direct diagnostic visualization and therapeutic intervention in the biliary tree. There is increasing evidence of its clinical utility in the assessment of biliary strictures and treatment of difficult stones.
  
  
  OBJECTIVE
  To describe the first reported Canadian experience with managing biliary disease using single-operator cholangioscopy.
  
  
  METHODS
  The present study was a retrospective analysis of data collected from all sequential patients undergoing single-operator cholangioscopy for assessment of biliary strictures and treatment of biliary stones. The main outcome measures were the ability to make an overall diagnosis of stricture (based on visual appearances and tissue histology), and to fragment and extract biliary stones.
  
  
  RESULTS
  Thirty patients (17 women), mean age 66 years (range 41 to 89 years) underwent single-operator cholangioscopy. In biliary strictures (20 patients), overall accuracy for visual and tissue diagnosis was 84% and 81%, respectively. Successful electrohydraulic lithotripsy with stone clearance was achieved in 90% of the 10 patients who failed previous conventional therapy. The mean (± SD) procedure time was 61±21 min (range 20 min to 119 min). One patient developed mild postendoscopic retrograde cholangioscopy pancreatitis.
  
  
  CONCLUSIONS
  The results of this experience reaffirms the clinical utility and safety of single-operator cholangioscopy for the management of biliary pathology. Further improvements can be achieved with increasing operator experience and refinements in optical technology.
authors: Division of Gastroenterology, University of Alberta Hospital, Edmonton, Alberta.
authors: Turki
authors: T
authors: Alameel
authors: Vincent
authors: V
authors: Bain
authors: Gurpal
authors: G
authors: Sandha
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001652:Bile Ducts / Q000473:pathology*; D001660:Biliary Tract Diseases / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D002170:Canada; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000379:methods*; D002769:Cholelithiasis / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D003251:Constriction, Pathologic / Q000175:diagnosis / Q000473:pathology; D005260:Female; D006801:Humans; D008096:Lithotripsy / Q000379:methods; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
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