title: Cholangioscopy in bile duct disease: a case series.
abstract: BACKGROUND
  Direct endoscopic visualization of biliopancreatic duct is certainly one of the greatest advances of therapeutic endoscopy. The use of a single-operator cholangioscopy platform (SpyGlass) is a promising technique in the evaluation of diseases such as indeterminate biliary stricture and giant choledocholitiasis. This is the first Brazilian case series using this technology.
  
  
  METHODS
  We report a case series of 20 patients in whom SpyGlass was used with diagnostic and therapeutic intention.
  
  
  RESULTS
  Most patients were female (60%) and the median age was 48 years (ranging from 14 to 94). Choledocholitiasis was the most common indication (12/20), and electrohydraulic lithotripsy was applied in eight (66%). Electrohydraulic lithotripsy was successful in seven (87.5%) patients. Partial stone fragmentation occurred in one patient with large stone causing stone-choledochal disproportion, which was conducted with biliary plastic stent placement and a second scheduled endoscopic approach in 3 months. In cases of undefined etiology of biliary strictures, it was possible to exclude malignancy due to direct visualization (7/8) or biopsy (1/8). One complication occurred (duodenal perforation) after papillary balloon dilation.
  
  
  CONCLUSIONS
  The use of SpyGlass demonstrated the benefits, especially in cases of large bile duct stones and indeterminate biliary strictures. Other potencial improvements such as reduction on radiation exposure should be confirmed in prospective studies.
authors.affiliation: Departamento de Gastroenterologia, Serviço de Endoscopia Gastrointestinal, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Eduardo Guimarães Hourneaux de
authors.initials: EG
authors.lastname: Moura
authors.affiliation: Departamento de Gastroenterologia, Serviço de Endoscopia Gastrointestinal, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Tomazo
authors.initials: T
authors.lastname: Franzini
authors.affiliation: Departamento de Gastroenterologia, Serviço de Endoscopia Gastrointestinal, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Renata Nobre
authors.initials: RN
authors.lastname: Moura
authors.affiliation: Departamento de Gastroenterologia, Serviço de Endoscopia Gastrointestinal, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Fred Olavo Aragão Andrade
authors.initials: FO
authors.lastname: Carneiro
authors.affiliation: Departamento de Gastroenterologia, Serviço de Endoscopia Gastrointestinal, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Everson Luiz de Almeida
authors.initials: EL
authors.lastname: Artifon
authors.affiliation: Departamento de Gastroenterologia, Serviço de Endoscopia Gastrointestinal, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Paulo
authors.initials: P
authors.lastname: Sakai
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001649:Bile Duct Diseases / Q000601:surgery*; D016145:Endoscopy, Digestive System / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult