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Improving Procedural Efficiency in Direct Peroral Cholangioscopy: A Retrospective Analysis of Intubation Time and
Wojciech Ciesielski1, Tomasz Klimczak1, Kacper Pawlak2
1Department of General and Transplant Surgery, Medical University of Lodz, Łódź, Poland.
Summary
Direct peroral cholangioscopy (DPOC) is safe and effective for biliary issues. Balloon-assisted methods significantly reduce intubation time compared to freehand techniques, improving procedural efficiency.
Area of Science:
- Gastroenterology
- Endoscopy
- Biliary Tract Procedures
Background:
- Direct peroral cholangioscopy (DPOC) enhances visualization and therapeutic options in biliary procedures.
- Limited comparative data exists on DPOC intubation methods and their efficiency.
Purpose of the Study:
- To evaluate success rates, complication rates, and intubation times for five distinct biliary intubation techniques in DPOC.
- To compare the efficiency of different intubation strategies for DPOC procedures.
Main Methods:
- Retrospective analysis of 36 consecutive DPOC procedures performed between December 2021 and March 2024.
- Assessment of five intubation methods: freehand, freehand with overtube, intraductal balloon, intraductal balloon with overtube, and intraductal balloon with overtube plus SEMS.
- Evaluation of indications including cholelithiasis, cholangiocarcinoma, prosthesis migration, and SEMS occlusion.
Main Results:
- 100% technical success rate for biliary intubation across all procedures.
- Zero complications reported (0%) in all 36 cases.
- Significant difference in mean intubation times between methods (P < .001), with intraductal balloon (73.3s) being faster than freehand (202.25s).
Conclusions:
- DPOC is a safe and effective endoscopic approach for diverse biliary pathologies.
- Accessory-assisted techniques, especially balloon-based methods, enhance DPOC procedural efficiency.
- Findings support wider DPOC adoption and selection of intubation strategies based on patient anatomy and clinical context.
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