title: An Overview of the Evolution of Direct Cholangioscopy Techniques for Diagnosis and Therapy.
abstract: Direct examination of the biliary tree with endoscopes has been a challenge since endoscopists began performing endoscopic retrograde cholangiopancreatography (ERCP) in the late 1960s. Previously, surgeons had used rigid instruments intraoperatively, which made examination difficult. The first direct cholangioscopy performed by an endoscopist was likely unintentionally done in a patient with postsurgical anatomy. Indirect imaging, ERCP, and percutaneous transhepatic cholangiography are helpful modalities for examining the biliary tree, but they are limited procedures, particularly with regard to the evaluation and treatment of strictures and bile duct stones. This article reviews the history and evolution of direct cholangioscopy since the advent of flexible endoscopes. Additionally, the article describes a new single-operator cholan-gioscopy technique for direct visualization of the biliary tree for diagnosis and intervention. There remains opportunity for innovation as endoscopists strive for safe and less-invasive methods for the identification and treatment of biliary pathology.
authors.affiliation: All of the authors are affiliated with Mount Sinai Beth Israel in New York, New York. Dr Voaklander and Dr Kim are residents in the Department of Internal Medicine. Dr Brown, Dr Kasmin, and Dr Siegel are attending physicians in the Department of Internal Medicine and founders of the Advanced Fellowship in Therapeutic Endoscopy. Dr Siegel is also a clinical professor of medicine at the Icahn School of Medicine at Mount Sinai in New York, New York.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Voaklander
authors.affiliation: All of the authors are affiliated with Mount Sinai Beth Israel in New York, New York. Dr Voaklander and Dr Kim are residents in the Department of Internal Medicine. Dr Brown, Dr Kasmin, and Dr Siegel are attending physicians in the Department of Internal Medicine and founders of the Advanced Fellowship in Therapeutic Endoscopy. Dr Siegel is also a clinical professor of medicine at the Icahn School of Medicine at Mount Sinai in New York, New York.
authors.forename: Eileen
authors.initials: E
authors.lastname: Kim
authors.affiliation: All of the authors are affiliated with Mount Sinai Beth Israel in New York, New York. Dr Voaklander and Dr Kim are residents in the Department of Internal Medicine. Dr Brown, Dr Kasmin, and Dr Siegel are attending physicians in the Department of Internal Medicine and founders of the Advanced Fellowship in Therapeutic Endoscopy. Dr Siegel is also a clinical professor of medicine at the Icahn School of Medicine at Mount Sinai in New York, New York.
authors.forename: William H
authors.initials: WH
authors.lastname: Brown
authors.affiliation: All of the authors are affiliated with Mount Sinai Beth Israel in New York, New York. Dr Voaklander and Dr Kim are residents in the Department of Internal Medicine. Dr Brown, Dr Kasmin, and Dr Siegel are attending physicians in the Department of Internal Medicine and founders of the Advanced Fellowship in Therapeutic Endoscopy. Dr Siegel is also a clinical professor of medicine at the Icahn School of Medicine at Mount Sinai in New York, New York.
authors.forename: Franklin E
authors.initials: FE
authors.lastname: Kasmin
authors.affiliation: All of the authors are affiliated with Mount Sinai Beth Israel in New York, New York. Dr Voaklander and Dr Kim are residents in the Department of Internal Medicine. Dr Brown, Dr Kasmin, and Dr Siegel are attending physicians in the Department of Internal Medicine and founders of the Advanced Fellowship in Therapeutic Endoscopy. Dr Siegel is also a clinical professor of medicine at the Icahn School of Medicine at Mount Sinai in New York, New York.
authors.forename: Jerome H
authors.initials: JH
authors.lastname: Siegel
keywords: Mother-daughter system; catheter-based system; percutaneous endoscopic extraction of retained stones; single-operator cholangioscopy; skinny-needle percutaneous transhepatic cholangiogram