title: Diagnostic and therapeutic cholangiopancreatoscopy: performance of a new digital cholangioscope.
abstract: BACKGROUND
  High-definition cholangioscopes provide excellent images of the pancreatobiliary ductal system and may play a significant role in diagnosis and treatment of various pancreatobiliary disorders.
  
  
  OBJECTIVE
  To assess the performance of a new digital cholangioscope for diagnosis and treatment of pancreatobiliary disorders in clinical practice.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Academic hospital, tertiary-care referral center.
  
  
  METHODS
  Consecutive patients with suspected pancreatobiliary disorders.
  
  
  METHODS
  Diagnostic or therapeutic high-definition digital cholangiopancreatoscopy.
  
  
  METHODS
  Satisfactory visualization of the ductal mucosa and lumen and treatment of pancreatobiliary disorders when indicated.
  
  
  RESULTS
  A total of 28 cholangioscopy and 4 pancreatoscopy procedures were completed before breakdown of the cholangioscope. Excellent views of the ductal lumen and mucosa were obtained in all patients. In the 18 patients with indeterminate biliary strictures, high-definition cholangioscopy identified all cholangiocarcinomas but labeled as malignant only 1 of 4 strictures caused by pancreatic cancer (sensitivity 73%). All benign strictures were correctly labeled (specificity 100%). Cholangioscopy proved helpful in evaluation of various biliary disorders and lithotripsy of pancreatic stones under direct vision.
  
  
  CONCLUSIONS
  Single center, small number of patients.
  
  
  CONCLUSIONS
  High-definition cholangioscopy is a useful adjunct to ERCP in the diagnosis and treatment of pancreatobiliary disorders. Although fragility of the cholangioscope remains a problem, the changes made in the construction of this prototype digital cholangioscope have significantly increased its durability.
authors.affiliation: Center for Endoscopy and Pancreatobiliary Disorders, Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Mansour A
authors.initials: MA
authors.lastname: Parsi
authors.affiliation: Center for Endoscopy and Pancreatobiliary Disorders, Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Sunguk
authors.initials: S
authors.lastname: Jang
authors.affiliation: Center for Endoscopy and Pancreatobiliary Disorders, Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Madhusudhan
authors.initials: M
authors.lastname: Sanaka
authors.affiliation: Center for Endoscopy and Pancreatobiliary Disorders, Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Tyler
authors.initials: T
authors.lastname: Stevens
authors.affiliation: Center for Endoscopy and Pancreatobiliary Disorders, Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Vargo
mesh_terms: D001649:Bile Duct Diseases / Q000175:diagnosis* / Q000628:therapy*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000295:instrumentation*; D004867:Equipment Design; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D062048:Narrow Band Imaging / Q000295:instrumentation*; D010182:Pancreatic Diseases / Q000175:diagnosis* / Q000628:therapy*; D011446:Prospective Studies