title: A new peroral mother-baby endoscope system for biliary tract disorders.
abstract: OBJECTIVE
  To investigate a new mother-baby system, consisting of a peroral cholangioscope and a duodenoscope in patients regarding its feasibility.
  
  
  METHODS
  In the study period from January 2007 to February 2010, 76 consecutive patients (33 men, 43 women; mean age 63 years old) were included in this pilot series. Endoluminal images and biopsies were obtained from 55 patients with indeterminate strictures, while 21 patients had fixed filling defects. The diagnostic accuracy of peroral cholangioscopy (POCS) in the visualization of strictures and tissue sampling was evaluated, and therapeutic success was monitored. Follow-up was performed over at least 9 mo.
  
  
  RESULTS
  A total of 55 patients had indeterminate strictures. Using the criteria "circular stenosis" and "irregular surface or margins", POCS correctly described 27 out of 28 malignant biliary strictures and 25 out of 27 benign lesions (sensitivity, 96.4%; specificity, 92.6%, diagnostic accuracy 94.5%). Visually targeted forceps biopsies were performed in 55 patients. Tissue sampling during POCS revealed malignancy in 18 of 28 cases (sensitivity: 64.3%). In 21 patients with fixed filling defects, 10 patients with bile duct stones were successfully treated with conventional stone removal. Nine patients with difficult stones (5 giant stones and 4 intrahepatic stones) were treated with visually guided laser lithotripsy. Two patients in the group with unclear fixed filling defects had bile duct adenoma or papillary tumors and were surgically treated.
  
  
  CONCLUSIONS
  The new 95 cm POCS allows for accurate discrimination of strictures and fixed filling defects in the biliary tree, provides improved sensitivity of endoscopically guided biopsies and permits therapeutic approaches for difficult intrahepatic stones.
authors: Christian Prinz, Stefanie Goecke, Medical Department, University of Witten, Lehrstuhl für Innere Medizin 2, Helios Klinikum Wuppertal, 42283 Wuppertal, Germany.
authors: Christian
authors: C
authors: Prinz
authors: Christian Prinz, Stefanie Goecke, Medical Department, University of Witten, Lehrstuhl für Innere Medizin 2, Helios Klinikum Wuppertal, 42283 Wuppertal, Germany.
authors: Andreas
authors: A
authors: Weber
authors: Christian Prinz, Stefanie Goecke, Medical Department, University of Witten, Lehrstuhl für Innere Medizin 2, Helios Klinikum Wuppertal, 42283 Wuppertal, Germany.
authors: Stefanie
authors: S
authors: Goecke
authors: Christian Prinz, Stefanie Goecke, Medical Department, University of Witten, Lehrstuhl für Innere Medizin 2, Helios Klinikum Wuppertal, 42283 Wuppertal, Germany.
authors: Bruno
authors: B
authors: Neu
authors: Christian Prinz, Stefanie Goecke, Medical Department, University of Witten, Lehrstuhl für Innere Medizin 2, Helios Klinikum Wuppertal, 42283 Wuppertal, Germany.
authors: Alexander
authors: A
authors: Meining
authors: Christian Prinz, Stefanie Goecke, Medical Department, University of Witten, Lehrstuhl für Innere Medizin 2, Helios Klinikum Wuppertal, 42283 Wuppertal, Germany.
authors: Eckart
authors: E
authors: Frimberger
keywords: Bile duct stenosis; Cholangioscopy; Endoscopic retrograde cholangiopancreatography; Peroral cholangioscopy; Stones, Mother baby endoscopy