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Related Concept Videos

Endoscopic Procedures V: ERCP01:26

Endoscopic Procedures V: ERCP

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Endoscopic Retrograde Cholangiopancreatography (ERCP) is a diagnostic procedure that combines endoscopy and fluoroscopy to diagnose and treat conditions related to the bile ducts, pancreatic ducts, and gallbladder. This procedure is beneficial for identifying and addressing blockages, gallstones, strictures, and tumors within the biliary or pancreatic systems. ERCP is both diagnostic and therapeutic, offering the ability to visualize and treat identified problems in one session.
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Endoscopic Procedures I: Esophagogastroduodenoscopy01:29

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An Esophagogastroduodenoscopy (EGD) is a diagnostic procedure in which an endoscopist uses a flexible, lighted endoscope to visualize the upper gastrointestinal (GI) tract. The procedure includes visualizing the oropharynx, esophagus, stomach, and the first part of the small intestine, the duodenum.
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Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy01:26

Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy

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Sigmoidoscopy and laparoscopy are distinct medical procedures that enable physicians to internally inspect different parts of the GI tract. Although they serve different purposes, each is essential for diagnosing and, in some cases, treating various medical conditions.
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Endoscopic Procedures II: Colonoscopy01:25

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The colon, or large intestine, is the final segment of the digestive system. Its primary functions include absorbing water and vitamins produced by gut bacteria and transforming waste from liquid to solid to form stool. In adults, the large intestine is approximately 5 feet long and consists of four main sections:
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Endoscopic Procedures III: Video Capsule Endoscopy01:28

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Capsule endoscopy, or wireless or video capsule endoscopy, is a diagnostic procedure for examining the entire gastrointestinal tract. Patients swallow a capsule about the size of a vitamin tablet. The capsule is equipped with a transmitter, a battery, an LED light source, and a color video camera to capture images throughout the gastrointestinal tract. This procedure is particularly useful for diagnosing conditions such as Crohn's disease, ulcerative colitis, tumors, polyps, ulcers,...
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The management of chronic pancreatitis is multifaceted, involving a comprehensive approach that includes thorough assessment, diagnostic testing, and a variety of management strategies.
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A Two-Step Method for Percutaneous Transhepatic Choledochoscopic Lithotomy
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Clinical Practice Guidelines for Peroral Cholangioscopy.

Kazumasa Nagai1, Akio Katanuma2, Shomei Ryozawa3

  • 1Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.

Journal of Hepato-Biliary-Pancreatic Sciences
|December 16, 2025
PubMed
Summary

The Japan Biliary Association developed evidence-based guidelines for peroral cholangioscopy (POCS) to standardize its use in diagnosing and treating biliary tract diseases in Japan.

Keywords:
biliary stricturescholangioscopy‐guided lithotripsyclinical practice guidelinesendoscopic retrograde cholangiopancreatographyperoral cholangioscopy (POCS)

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Area of Science:

  • Gastroenterology
  • Endoscopy
  • Biliary Tract Diseases

Background:

  • Peroral cholangioscopy (POCS) is a key endoscopic tool for biliary tract diseases.
  • No standardized clinical practice guidelines for POCS existed in Japan previously.

Purpose of the Study:

  • To develop evidence-based guidelines for the safe and effective implementation of POCS in Japan.
  • To provide a standardized framework for POCS procedures and management.

Main Methods:

  • A multidisciplinary committee formulated 31 questions across six domains.
  • Recommendations were based on systematic literature review and expert consensus following Minds 2020 methodology.

Main Results:

  • Guidelines cover indications, antithrombotic therapy, papillary intervention, antibiotic prophylaxis, and procedural risks.
  • POCS utility in indeterminate strictures, cholangiocarcinoma, and bile duct stones is highlighted.
  • Adverse events like cholangitis and perforation are addressed.

Conclusions:

  • These guidelines offer a practical reference for clinicians and endoscopists.
  • Guidelines allow for adaptation based on institutional practices and patient characteristics.