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Review
. 2023 Sep 13;13(18):2933.
doi: 10.3390/diagnostics13182933.

The Role of Cholangioscopy in Biliary Diseases

Aurelio Mauro  1 , Stefano Mazza  1 , Davide Scalvini  1   2 , Francesca Lusetti  1   2 , Marco Bardone  1 , Pietro Quaretti  3 , Lorenzo Cobianchi  4 , Andrea Anderloni  1
Affiliations
Review

The Role of Cholangioscopy in Biliary Diseases

Aurelio Mauro et al. Diagnostics (Basel). .

Abstract

Endoscopy plays a central role in diagnostic and therapeutic approaches to biliary disease in both benign and malignant conditions. A cholangioscope is an endoscopic instrument that allows for the direct exploration of the biliary tree. Over the years, technology has improved endoscopic image quality and allowed for the development of an operative procedure that can be performed during cholangioscopy. Different types of instruments are available in this context, and they can be used in different anatomical access points according to the most appropriate clinical indication. The direct visualization of biliary mucosa is essential in the presence of biliary strictures of unknown significance, allowing for the appropriate allocation of patients to surgery or conservative treatments. Cholangioscopy has demonstrated excellent performance in discriminating malignant conditions (such as colangiocarcinoma) from benign inflammatory strictures, and more recent advances (e.g., artificial intelligence and confocal laser endomicroscopy) could further increase its diagnostic accuracy. Cholangioscopy also plays a primary role in the treatment of benign conditions such as difficult bile stones (DBSs). In this case, it may not be possible to achieve complete biliary drainage using standard ERCP. Therapeutic cholangioscopy-guided lithotripsy allows for stone fragmentation and complete biliary drainage. Indeed, other complex clinical situations, such as patients with intra-hepatic lithiasis and patients with an altered anatomy, could benefit from the therapeutic role of cholangioscopy. The aim of the present review is to explore the most recent diagnostic and therapeutic advances in the roles of cholangioscopy in the management of biliary diseases.

Keywords: Mirizzi syndrome; artificial intelligence; cholangioscopy; difficult bile stones; direct peroral cholangioscopy; hepaticogastrostomy; indeterminate biliary stricture; intrahepatic stones; percutaneous cholangioscopy; surgical cholangioscopy.

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Conflict of interest statement

Andrea Anderloni is a Consultant for Boston Scientific and Olympus.

Figures

Figure 1
Figure 1
Digital version of the single-operator cholangioscope (DSOC) (SpyGlass, Boston Scientific Endoscopy, Marlboro, MA, USA). (A) The cholangioscope in its full length (214 cm) attached with a catheter cable (white catheter) to the cable connector (black star). (B) Details of the attachment strap (blue part), which allows for the cholangioscope to be fixed to the shaft of the duodenoscope; the Y-port adapter, with a working channel for accessory access (black star); and the irrigation–aspiration port (black cross). (C) Details of the tip of the cholangioscope, featuring two LED lights and two irrigation channels. (D) Details of the two wheels capable of four types of movement and the articulation lock.
Figure 2
Figure 2
56-year-old female with intrahepatic multiple lithiasis of the sixth segment. Per-oral cholangioscopy was not feasible for the presence of an inflammatory stricture below the stones. Percutaneous cholangioscopy was performed with complete clearance of stones. (A) Multiple stones in the sixth liver segment (white arrow) above the biliary stricture (white asterisk); (B) percutaneous drainage; (C) radiological view of percutaneous cholangioscopy with electrohydraulic lithotripsy probe; (D) percutaneous cholangiography showing complete clearance of the sixth biliary segment.
Figure 3
Figure 3
Laparoscopic trans-cystic cholangioscopy with a small stone in the distal common bile duct. (A) Clipped cystic duct; (B) cholangioscopy insertion in a guidewire inside the cystic duct; (C) cholangioscopic view of the small stone that was removed with a retrieval basket.
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