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The Scope of Percutaneous Biliary Cholangioscopy: Beyond Choledocholithiasis
Jake DiFatta1, Chase Mahler1, Alyssa Knight1
1Division of Interventional Radiology, Department of Radiology, University of Alabama Birmingham, Birmingham, Alabama, USA.
Journal of Digestive Diseases
|January 12, 2026
Summary
Percutaneous cholangioscopy (PC) offers direct visualization of the biliary tree for complex conditions beyond common bile duct stones. This minimally invasive technique aids in diagnosing and managing challenging biliary and pancreatic pathologies when other methods fail.
Area of Science:
- Gastroenterology and Hepatology
- Interventional Endoscopy
- Biliary and Pancreatic Diseases
Background:
- The utility of percutaneous cholangioscopy (PC) for choledocholithiasis is established.
- Its role in managing less common biliary and pancreatic pathologies is expanding.
- PC presents unique advantages and drawbacks compared to other diagnostic and therapeutic modalities.
Purpose of the Study:
- To explore less-defined indications for percutaneous cholangioscopy (PC).
- To review the expanding role of PC in treating biliary and pancreatic pathologies.
- To focus on PC applications beyond the treatment of choledocholithiasis.
Main Methods:
- A thematic review of PubMed-reported PC indications since January 1, 2000.
- Extraction, synthesis, and analysis of relevant data.
- Identification of trends and gaps in PC utilization.
Main Results:
- Key indications include indeterminate biliary strictures, tumor staging, primary sclerosing cholangitis, hemobilia, foreign body retrieval, and pancreatic pathologies.
- PC is employed when endoscopic retrograde cholangiopancreatography (ERCP) or magnetic resonance cholangiopancreatography (MRCP) are insufficient or contraindicated due to complexity, anatomy, or cost.
- PC complication rates are comparable to ERCP, with slightly higher cholangitis rates manageable with antibiotics.
Conclusions:
- Percutaneous cholangioscopy provides direct visual inspection of the biliary tree.
- It allows for better appreciation and management of biliary pathology not amenable to other endoscopic techniques.
- PC is a valuable tool for complex biliary conditions.
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