Peroral direct cholangioscopy using an ultra–slim gastroscopy assisted by a snare

Abstract

Objective To evaluate the feasibility of diagnostic and therapeutic peroral direct cholangioscopy (PDCS) using an ultra–slim upper endoscopy assisted by a snare. Methods Between November 2014 and January 2015, 8 patients underwent PDCS with assistance of an ultra–slim endoscopy. After endoscopic papillary balloon dilation, the duodenoscopy was withdrew, an ultra–slim endoscopy was inserted directly into the biliary tract assisted by a snare, and biopsy or laser lithotripsy was performed. The snare was closed tightly in the bent portion of the scope, and the snare was pulled while scope shaft had to become the form of U loop by counterclockwise rotation, in order to advance the scope into common bile duct. Results PDCS succeeded in all eight cases, one common hepatic duct adenoma was diagnosed by biopsy, and confirmed by surgery; one benign biliary stricture was diagnosed by PDCS; laser lithotripsy was successfully performed in 4 patients with large CBD stones; bile duct clearance was verified by PDCS in two patients who was suspected of residual CBD stones. No perforation, bleeding or post–operative pancreatitis was found. Conclusion PDCS using an ultra–slim gastroscopy assisted by a snare is a safe, simple and practical procedure in the diagnosis and treatment of biliary tract diseases. Key words: Biliary tract diseases; Choledocholithiasis; Gastroscopes; Lithotripsy, laser; Peroral direct cholangioscopy