[Peroral and percutaneous transhepatic cholangioscopy]

Area of Science:

• Gastroenterology and Hepatology
• Minimally Invasive Procedures
• Diagnostic Imaging

Context:

• Biliary diseases often present diagnostic challenges, requiring advanced visualization beyond conventional imaging.
• Unclear biliary stenoses and lesions necessitate precise characterization for effective management.
• Management of difficult bile duct stones often requires alternative endoscopic or surgical interventions.

Purpose:

• To evaluate the diagnostic and therapeutic utility of cholangioscopy in managing complex biliary diseases.
• To compare the efficacy and safety of peroral versus percutaneous transhepatic cholangioscopy.
• To assess the role of cholangioscopy in improving preoperative staging and treatment planning for biliary lesions.

Summary:

• Cholangioscopy, combined with histology, provides crucial diagnostic information for unclear biliary diseases, surpassing indirect imaging methods.
• It enables differentiation of stenoses and protruded lesions, potentially improving preoperative staging through precise mapping of intraductal lesion extension.
• Cholangioscopic electrohydraulic lithotripsy and laser treatment offer safe and effective alternatives for stones resistant to conventional endoscopy.
• Peroral cholangioscopy allows rapid biliary tree visualization when the papilla is accessible, while percutaneous transhepatic cholangioscopy addresses complex anatomies and inaccessible lesions.

Impact:

• Enhances diagnostic accuracy in challenging biliary conditions, leading to more tailored treatment strategies.
• Provides minimally invasive therapeutic options for bile duct stones, reducing the need for surgery.
• Improves patient outcomes through better preoperative assessment and precise management of biliary tract pathologies.