Initial experience of visualized biliary cannulation during ERCP.

Area of Science:

• Gastroenterology
• Endoscopy
• Biliary Interventions

Background:

• Selective biliary cannulation in ERCP is difficult due to reliance on indirect imaging.
• A novel endoscopic retrograde direct cholangioscopy (ERDC) technology was developed to enable direct visualization during biliary cannulation.

Purpose of the Study:

• To evaluate the feasibility and safety of ERDC for biliary cannulation in patients with common bile duct stones.
• To assess the learning curve effect of ERDC by comparing early and later cases.

Main Methods:

• A case series involving 21 patients with common bile duct stones treated with ERDC between July and December 2022.
• Detailed recording of procedure, complications, and 3-month follow-up.
• Analysis of learning curve by comparing early and late procedural phases.

Main Results:

• Successful biliary cannulation was achieved in all patients, leading to complete stone removal.
• Median cannulation time was 240 seconds (IQR 10-430), with a median of 2 cannulations (IQR 1-5).
• Low complication rates observed (1 post-ERCP pancreatitis, 1 cholangitis, 3 asymptomatic hyperamylasemia), with full recovery and no serious adverse events during follow-up. Later cases showed reduced intubations and guidewire use.

Conclusions:

• Endoscopic retrograde direct cholangioscopy (ERDC) is a feasible technology for direct visual guidance during biliary cannulation.
• ERDC demonstrates safety and efficacy in the management of common bile duct stones.
• The technology shows potential for improving the challenging biliary cannulation step in ERCP.