title: Intraductal biliopancreatic imaging: European Society of Gastrointestinal Endoscopy (ESGE) technology review.
abstract: This technology review expresses the current view of the European Society of Gastrointestinal Endoscopy (ESGE) on the available techniques for intraductal biliopancreatic imaging. The three cholangioscopy techniques are described: the "dual-operator" and " single-operator" mother-baby approaches using dedicated instruments, and the "direct" technique using currently available ultrathin gastroscopes. The mother-baby method is standardized and reproducible, while direct cholangioscopy is technically demanding and its safety requires further evaluation. As well as direct visualization of the bile ducts, cholangioscopy has the further advantage of allowing targeted biopsy. Image quality is still suboptimal for single-operator cholangioscopy, while the other techniques have achieved adequately detailed imaging. The costs of mother-baby cholangioscopy are high and its application in clinical practice should be restricted to selected cases (i.e. indeterminate biliary strictures/intraluminal lesions, difficult biliary stones) and to the setting of tertiary care centers. Peroral pancreatoscopy may find an indication in situations where other imaging modalities (mainly EUS) are inconclusive (i.e. delineation of main duct intraductal papillary mucinous neoplasia extension, sampling of indeterminate main pancreatic duct strictures). Intraductal ultrasonography (IDUS) has a poorer performance than EUS in the staging of pancreatic malignancies and can increase the risk of pancreatitis. A promising indication for IDUS could be the evaluation of indeterminate biliary strictures and ampullary tumors. Probe-based confocal laser endomicroscopy (pCLE) of the bile ducts is a difficult and expensive technique. Appropriate training needs to be established, since interpretation of images is challenging. pCLE can be an important diagnostic tool in the setting of indeterminate biliary strictures.
authors.affiliation: Digestive Endoscopy Unit, Catholic University, Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Tringali
authors.affiliation: Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Brussels, Belgium.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Lemmers
authors.affiliation: Department of Gastroenterology and Interventional Endoscopy, Klinikum Friedrichshain, Berlin, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Meves
authors.affiliation: Department of Internal Medicine, Evangelisches Krankenhaus, Düsseldorf, Germany.
authors.forename: Grischa
authors.initials: G
authors.lastname: Terheggen
authors.affiliation: Department of Gastroenterology and Interventional Endoscopy, Klinikum Friedrichshain, Berlin, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Pohl
authors.affiliation: Department of Gastroenterology, Maggiore Hospital, Crema, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Manfredi
authors.affiliation: Department of Internal Medicine, St. Elisabeth Hospital,Vienna, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Häfner
authors.affiliation: Digestive Endoscopy Unit, Catholic University, Rome, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Costamagna
authors.affiliation: Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Brussels, Belgium.
authors.forename: Jacques
authors.initials: J
authors.lastname: Devière
authors.affiliation: Department of Internal Medicine, Evangelisches Krankenhaus, Düsseldorf, Germany.
authors.forename: Horst
authors.initials: H
authors.lastname: Neuhaus
authors.affiliation: Endoscopy Unit, Paoli-Calmettes Institute, Marseille, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Caillol
authors.affiliation: Endoscopy Unit, Paoli-Calmettes Institute, Marseille, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Giovannini
authors.affiliation: Department of Gastroenterology, Nuovo Regina Margherita Hospital, Rome, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Hassan
authors.affiliation: Gedyt Endoscopy Center, Buenos Aires, Argentina.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Dumonceau
mesh_terms: D001649:Bile Duct Diseases / Q000175:diagnosis*; D001652:Bile Ducts; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005060:Europe; D005762:Gastroenterology; D006801:Humans; D010182:Pancreatic Diseases / Q000175:diagnosis*; D012955:Societies, Medical