Direct peroral cholangioscopy with conventional upper gastrointestinal endoscope

Area of Science:

• Gastroenterology
• Endoscopy
• Biliary Interventions

Background:

• Acute cholangitis management in patients with altered anatomy, such as post-Whipple procedure, presents unique challenges.
• Conventional endoscopic retrograde cholangiopancreatography (ERCP) may be difficult due to anatomical variations.

Observation:

• An 83-year-old male with a history of pancreatic cancer and Whipple procedure presented with acute cholangitis.
• Severe hepaticojejunal anastomotic stricture was identified.
• Residual cholesterol stones were found in the left hepatic duct branches.

Findings:

• Upper gastrointestinal endoscopy was utilized for peroral cholangioscopy due to altered anatomy.
• Successful dilation of the anastomotic stricture with a 12mm TTS balloon was achieved.
• Bile duct stones and pus were extracted; residual stones were removed using a cholangioscopy stone extraction balloon.

Implications:

• Direct peroral cholangioscopy using conventional endoscopes offers high-quality imaging and interventional capabilities for complex biliary cases.
• This approach is effective and economical for confirming bile duct stone clearance and removing residual stones.
• Development of cost-effective peroral cholangioscopy scopes is needed to enhance safety and success rates.