Direct cholangioscopy: the North Shore experience.

Objective: Endoscopic retrograde cholangiopancreatography (ERCP) has long been a tool utilized by gastroenterologists for many years, but direct cholangioscopy has only recently begun to be available for regular use in clinical practice. The focus of this study was to evaluate the efficacy of a direct cholangioscopy system and its indications within our patient population.

Materials And Methods: This retrospective analysis was carried out at North Shore University Hospital. After obtaining institutional review board approval, the charts of patients who had undergone cholangioscopy from January 2007 through October 2011 were reviewed. An excel spreadsheet was created to record demographic information, significant laboratory data, indications for ERCP, ERCP findings, indication for cholangioscopy, findings, interventions, and biopsy results (if performed). A total of 34 cases were included in the final review.

Results: Cholangioscopy indications included incomplete or failed stone removal, biliary stricture evaluation, and retrieval of a migrated biliary stent, among others. Electrohydraulic lithotripsy was utilized with almost complete success in cases of previous failed stone removal. In 12 cases where a cholangioscopy-directed biopsy was performed, adequate tissue was obtained in all cases, and aided in the exclusion of malignancy.

Conclusion: Direct cholangioscopy is a new technology whose use is currently limited in clinical practice, but is growing in popularity. Its continued recognition as an important adjunct in the management of biliary and pancreatic disease should prompt further research into its use of a prospective nature. Given the limited number of direct cholangioscopy cases performed every year, large, randomized-controlled studies evaluating its efficacy and effect on outcomes have not yet been performed, but small studies may still continue to yield valuable information on its efficacy and safety.