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Cholangioscopy is a diagnostic and therapeutic procedure used to visualize and treat disorders of the bile ducts. It involves the use of a specialized endoscope called a cholangioscope, which is a thin, flexible tube with a light and camera attached to it. Cholangioscopy allows direct visualization of the bile ducts, enabling the detection of abnormalities and the performance of various interventions.

There are two main types of cholangioscopy:

  • Direct Cholangioscopy
  • Spyglass Cholangioscopy

Why and when is it done

Cholangioscopy can be performed for both diagnostic and therapeutic purposes. Some common indications for cholangioscopy include:

  • 1. Evaluation of bile duct strictures, tumors, or abnormalities that cannot be adequately visualized by other imaging techniques, such as ultrasound or magnetic resonance cholangiopancreatography (MRCP).
  • 2. Assessment of suspected bile duct stones or residual stones after previous interventions.
  • 3. Biopsy of suspicious lesions or tumors within the bile ducts.
  • 4. Guidance and monitoring of therapeutic procedures, such as stone removal, dilation of strictures, or placement of stents.

Benefits of Cholangioscopy

Some of the key benefits of cholangioscopy include:

  • Direct visualization of the bile ducts
  • Accurate diagnosis by directly visualizing the bile ducts, cholangioscopy can help in obtaining tissue samples for biopsy.
  • Targeted interventions: Cholangioscopy allows for targeted therapeutic interventions.
  • Cholangioscopy can be used to assess the effectiveness of previous interventions or treatments.
  • In some cases, cholangioscopy can help avoid the need for more invasive surgical procedures.
  • Minimally invasive approach

Risks associated with Cholangioscopy

As with any medical procedure, there are potential risks and complications associated with cholangioscopy. These can include pancreatitis, infection, bleeding, perforation of the bile duct, and adverse reactions to sedation or contrast agents. However, these complications are relatively rare, and the benefits of cholangioscopy in diagnosing and treating bile duct disorders often outweigh the risks.

How is the procedure performed

There are two main types of cholangioscopy:

  • Direct Cholangioscopy: In this technique, the cholangioscope is inserted directly into the bile duct through an existing opening, such as a surgical incision or a previously placed stent. This approach allows close inspection of the bile ducts and targeted interventions, such as taking biopsies, removing stones or foreign bodies, and performing laser therapy or electrocautery.
  • Spyglass Cholangioscopy: Spyglass cholangioscopy utilizes a miniature cholangioscope that is passed through the working channel of a standard endoscope or an endoscopic retrograde cholangiopancreatography (ERCP) scope. The cholangioscope is advanced through the bile ducts, and the images are transmitted to a monitor for visualization. Spyglass cholangioscopy is primarily used for visual examination and can assist in identifying stones, strictures, tumors, and other abnormalities within the bile ducts.