Per oral cholangiopancreatoscopy in pancreatico biliary diseases--expert consensus statements.
OBJECTIVE
To provide consensus statements on the use of per-oral cholangiopancreatoscopy (POCPS).


METHODS
A workgroup of experts in endoscopic retrograde cholangiopancreatography (ERCP), endosonography, and POCPS generated consensus statements summarizing the utility of POCPS in pancreaticobiliary disease. Recommendation grades used validated evidence ratings of publications from an extensive literature review.


RESULTS
Six consensus statements were generated: (1) POCPS is now an important additional tool during ERCP; (2) in patients with indeterminate biliary strictures, POCS and POCS-guided targeted biopsy are useful for establishing a definitive diagnosis; (3) POCS and POCS-guided lithotripsy are recommended for treatment of difficult common bile duct stones when standard techniques fail; (4) in patients with main duct intraductal papillary mucinous neoplasms (IPMN) POPS may be used to assess extent of tumor to assist surgical resection; (5) in difficult pancreatic ductal stones, POPS-guided lithotripsy may be useful in fragmentation and extraction of stones; and (6) additional indications for POCPS include selective guidewire placement, unexplained hemobilia, assessing intraductal biliary ablation therapy, and extracting migrated stents.


CONCLUSIONS
POCPS is important in association with ERCP, particularly for diagnosis of indeterminate biliary strictures and for intra-ductal lithotripsy when other techniques failed, and may be useful for pre-operative assessment of extent of main duct IPMN, for extraction of difficult pancreatic stones, and for unusual indications involving selective guidewire placement, assessing unexplained hemobilia or intraductal biliary ablation therapy, and extracting migrated stents.
Mohan Ramchandani, Duvvur Nageshwar Reddy, Sundeep Lakhtakia, Manu Tandan, Asian Institute of Gastroenterology, Hyderabad 500082, India.
Mohan
M
Ramchandani
Mohan Ramchandani, Duvvur Nageshwar Reddy, Sundeep Lakhtakia, Manu Tandan, Asian Institute of Gastroenterology, Hyderabad 500082, India.
Duvvur Nageshwar
DN
Reddy
Mohan Ramchandani, Duvvur Nageshwar Reddy, Sundeep Lakhtakia, Manu Tandan, Asian Institute of Gastroenterology, Hyderabad 500082, India.
Sundeep
S
Lakhtakia
Mohan Ramchandani, Duvvur Nageshwar Reddy, Sundeep Lakhtakia, Manu Tandan, Asian Institute of Gastroenterology, Hyderabad 500082, India.
Manu
M
Tandan
Mohan Ramchandani, Duvvur Nageshwar Reddy, Sundeep Lakhtakia, Manu Tandan, Asian Institute of Gastroenterology, Hyderabad 500082, India.
Amit
A
Maydeo
Mohan Ramchandani, Duvvur Nageshwar Reddy, Sundeep Lakhtakia, Manu Tandan, Asian Institute of Gastroenterology, Hyderabad 500082, India.
Thoguluva Seshadri
TS
Chandrashekhar
Mohan Ramchandani, Duvvur Nageshwar Reddy, Sundeep Lakhtakia, Manu Tandan, Asian Institute of Gastroenterology, Hyderabad 500082, India.
Ajay
A
Kumar
Mohan Ramchandani, Duvvur Nageshwar Reddy, Sundeep Lakhtakia, Manu Tandan, Asian Institute of Gastroenterology, Hyderabad 500082, India.
Randhir
R
Sud
Mohan Ramchandani, Duvvur Nageshwar Reddy, Sundeep Lakhtakia, Manu Tandan, Asian Institute of Gastroenterology, Hyderabad 500082, India.
Rungsun
R
Rerknimitr
Mohan Ramchandani, Duvvur Nageshwar Reddy, Sundeep Lakhtakia, Manu Tandan, Asian Institute of Gastroenterology, Hyderabad 500082, India.
Dadang
D
Makmun
Mohan Ramchandani, Duvvur Nageshwar Reddy, Sundeep Lakhtakia, Manu Tandan, Asian Institute of Gastroenterology, Hyderabad 500082, India.
Christopher
C
Khor
D001660:Biliary Tract Diseases / Q000175:diagnosis* / Q000628:therapy*; D001706:Biopsy; D002760:Cholangiopancreatography, Endoscopic Retrograde; D032921:Consensus; D003697:Delphi Technique; D016145:Endoscopy, Digestive System / Q000009:adverse effects / Q000379:methods*; D019317:Evidence-Based Medicine; D006801:Humans; D010182:Pancreatic Diseases / Q000175:diagnosis* / Q000628:therapy*; D011237:Predictive Value of Tests; D016896:Treatment Outcome
Cholangioscopy; Indeterninate biliary strictures; Intraductal lithotripsy; Pancreatoscopy; Per oral cholangiopancreatoscopy