The Scope of Percutaneous Biliary Cholangioscopy: Beyond Choledocholithiasis

To discuss less well-defined indications for percutaneous cholangioscopy (PC) that have been described in case reports and other studies. The role of PC is expanding in the treatment of biliary and pancreatic pathologies and presents unique advantages and drawbacks when compared to other endovascular diagnostic and therapeutic modalities. The utility of cholangioscopy in the treatment of choledocholithiasis has been well defined, and therefore here we focus on other indications.

A thematic review was conducted by searching PubMed for studies reporting indications for PC since January 1, 2000. Relevant data were extracted, synthesized, and analyzed to identify trends and gaps in the use of this procedure.

Indications for PC include indeterminate biliary strictures, tumor evaluation and staging, primary sclerosing cholangitis (PSC), hemobilia, foreign object retrieval, and pancreatic pathologies, and so on. PC is generally used when other techniques such as endoscopic retrograde cholangiopancreatography (ERCP) or magnetic resonance cholangiopancreatography (MRCP) are insufficient or contraindicated. Reasons for this include technical complexity, anatomic abnormalities, and cost. PC has similar rates of complication as other biliary techniques such as ERCP, albeit marginally higher rates of cholangitis, which can be successfully mitigated with antibiotics.

PC enables direct visual inspection of the biliary tree with correlative cholangiography to better appreciate and manage biliary pathology not amenable to peroral cholangioscopy, ERCP, or MRCP.