Direct insertion of an ultra-slim upper endoscope for cholangioscopy in patients undergoing choledochoduodenostomy.
Direct peroral cholangioscopy (POC) using an ultra-slim upper endoscope is one modality of POC for intraductal endoscopic evaluation and treatment of the bile duct. Choledochoduodenostomy (CDS) is one modality of biliary bypass surgery that provides a new route to the bile duct. We carried out direct POC using an ultra-slim upper endoscope without the use of accessories in 10 patients (four sump syndromes, three bile duct strictures and three intrahepatic duct stones) previously undergoing surgical CDS. Direct POC was successful in all patients. The use of an intraductal balloon catheter was required in one patient for advancement of the endoscope into the bile duct. Distal bile ducts with sump syndromes were cleared using baskets and water irrigation under direct POC. Cholangiocarcinoma was diagnosed in one patient with hilar bile duct stricture after cholangioscopic evaluation and a targeting forceps biopsy under direct POC. Intrahepatic duct stones were successfully extracted after intraductal fragmentation under direct POC. Oozing bleeding occurred during intraductal lithotripsy but stopped spontaneously. Direct POC using an ultra-slim upper endoscope without the assistance of accessories can easily be carried out in patients undergoing CDS.
Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon and Seoul, Korea.
Hyun Jong
HJ
Choi
Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon and Seoul, Korea.
Jong Ho
JH
Moon
Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon and Seoul, Korea.
Yun Nah
YN
Lee
Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon and Seoul, Korea.
Hyun Su
HS
Kim
Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon and Seoul, Korea.
Ji Su
JS
Ha
Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon and Seoul, Korea.
Tae Hoon
TH
Lee
Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon and Seoul, Korea.
Sang-Woo
SW
Cha
Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon and Seoul, Korea.
Young Deok
YD
Cho
Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon and Seoul, Korea.
Sang-Heum
SH
Park
D001650:Bile Duct Neoplasms / Q000175:diagnosis / Q000601:surgery*; D002768:Choledochostomy / Q000379:methods*; D019723:Endoscopes; D016145:Endoscopy, Digestive System / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D006801:Humans; D018285:Klatskin Tumor / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D008904:Miniaturization; D057605:Natural Orifice Endoscopic Surgery / Q000295:instrumentation*
Klatskin tumor; altered gastrointestinal anatomy; choledochoduodenostomy; direct peroral cholangioscopy; sump syndrome