Digital, Catheter-Based Single-Operator Cholangiopancreatoscopes: Can Pancreatoscopy and Cholangioscopy Become Routine Procedures?

Abstract

Working length 214cm Accessory channel diameter 1.2mm (3.6 French) outine visualization of the pancreatobiliary ductal Rsystem is probably the last endoscopic frontier in the alimentary tract. Although miniature endoscopes for insertion into the biliary or pancreatic ducts have been around for many years, cholangioscopy and pancreatoscopy are yet to become routine procedures. Performance of these procedures has remained mostly confined to large academic medical centers because of a variety of factors including lack of access to appropriate equipment, lack of expertise, and lack of user-friendliness of currently available endoscopes. The birth of catheter-based cholangiopancreatoscopes in the last decade by introduction of the Spyglass Direct Visualization System (DVS) (Boston Scientific, Natick, MA) led to more widespread use of cholangiopancreatoscopy. However, due to less that optimal image quality, the initial enthusiasm for routine use of this device soon faded. A new version of this catheter-based system with improved digital image has now been released. This article and the accompanying video present the use of this new technology in the pancreatobiliary ductal system and illustrate how it may lead to more widespread use of cholangiopancreatoscopy.