Update on biliary endoscopy

Since the introduction of endoscopic retrograde cholangiopancreatography, there have been great improvements in the technique, equipment, and clinical utility of biliary endoscopy. In many cases, therapeutic endoscopic retrograde cholangiopancreatography can take the place of invasive surgery, including common bile duct exploration, thereby decreasing the patient's morbidity and recuperation time. Even with advances, such as stent placement for biliary strictures in a patient after liver transplantation, there is still room for improvement.

Research over the past year has been focused on areas including improved imaging and tissue sampling of the biliary tree through endoscopic ultrasound techniques, better identification of patients at risk for pancreatitis after endoscopic retrograde cholangiopancreatography, and refinements in photodynamic therapy for the treatment of cholangiocarcinoma. International research has continued to emphasize biliary sphincterotomy compared with balloon dilation for the management of choledocholithiasis. Further developments in other fields, such as living related liver transplantation, provide challenges for the biliary endoscopist.

This review focuses on some of the work being performed in the field of biliary endoscopy. The key studies were chosen to highlight some of the areas currently being investigated as well as to indicate certain fields that need further development.