PERORAL CHOLANGIOSCOPY: AN IMPROVED PROCEDURE

Cholangioscopy provides direct visual assessment of the bile ducts, tissue sampling, and therapeutic interventions. Delineation of intraductal lesions equivocal with direct cholangiography, differentiation between malignant and benign biliary strictures, and assessment of longitudinal extent of cholangiocarcinoma are major indicators for diagnostic cholangioscopy. Peroral cholangioscopy is readily performed at an initial endoscopic retrograde cholangiopancreatography. Owing to substantial refinement in terms of image quality and technical feasibility achieved with the development of a new video cholangioscope, peroral cholangioscopy has become a powerful tool. However, compared with percutaneous cholangioscopy, there remain several disadvantages in peroral cholangioscopy: less favorable maneuverability, small instrumental channel, and limited therapeutic instrumentations. With further advances in endoscopic functions and increasing availability of suitable instruments, peroral cholangioscopy, because of its less invasiveness, will become mandatory for diagnostic and therapeutic biliary endoscopy.