title: Efficacy and safety of direct transnasal cholangioscopy with standard ultraslim endoscopes: results of a large cohort study.
abstract: BACKGROUND
  Direct cholangioscopy (DC) with ultraslim endoscopes and free-hand cannulation of the common bile duct (CBD) is a promising technique for evaluating and treating cholangiopathy. However, its safety and success rates are as yet unclear.
  
  
  OBJECTIVE
  To evaluate the overall success rates and adverse events with the procedure.
  
  
  METHODS
  Single-center, prospective cohort study; 12 patients retrospectively enrolled.
  
  
  METHODS
  Academic tertiary referral center.
  
  
  METHODS
  A total of 100 DC procedures in 84 patients with biliary disease were evaluated prospectively.
  
  
  METHODS
  DC performed with the patient under conscious sedation.
  
  
  METHODS
  Overall success rates and adverse events with the procedure.
  
  
  RESULTS
  In 34 cases with small- or medium-sized sphincterotomies, sphincteroplasty was performed with a 10-mm dilating balloon before DC. The intraductal area of interest was successfully accessed in 87% of the procedures. The intended interventions were successfully carried out in 81 patients (93.1%), but failed in 6 (6.9%). In patients without significant strictures, intrahepatic exploration of the bile ducts beyond the level of the bifurcation was feasible in only 10.8%. The mean total procedure time was 38.6 ± 12.2 minutes. Adverse events occurred in 12 procedures (12%) and were managed conservatively.
  
  
  CONCLUSIONS
  All procedures were performed by 1 endoscopist.
  
  
  CONCLUSIONS
  DC is safe and allows direct, high-resolution examination and a wide range of therapeutic options in the bile ducts in the majority of patients with biliary disease. However, the range of access is limited to the main bile duct. Suspected pathology restricted to the proximal intrahepatic ducts beyond the bifurcation is therefore not a good indication for DC.
authors.affiliation: Department of Internal Medicine II, Dr Horst Schmidt Kliniken (Medical School of the University of Mainz), Wiesbaden, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Meves
authors.affiliation: Department of Internal Medicine II, Dr Horst Schmidt Kliniken (Medical School of the University of Mainz), Wiesbaden, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Ell
authors.affiliation: Department of Internal Medicine II, Dr Horst Schmidt Kliniken (Medical School of the University of Mainz), Wiesbaden, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Pohl
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000473:pathology* / Q000601:surgery; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000473:pathology* / Q000601:surgery; D042883:Choledocholithiasis / Q000628:therapy; D016292:Procedural Sedation; D016145:Endoscopy, Digestive System / Q000009:adverse effects* / Q000295:instrumentation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009666:Nose; D061646:Operative Time; D011446:Prospective Studies
keywords: CBD; DC; ERC; IROI; common bile duct; direct cholangioscopy; endoscopic retrograde cholangiography; intraductal region of interest