Cholangiopancreatoscopy: Expanding the Diagnostic Indications of Endoscopic Retrograde Cholangiopancreatography

Abstract

Besides the adverse effects associated with endoscopic retrograde cholangiopancreatography (ERCP), indirect visualization of the biliopancreatic system through fluoroscopy has limited its diagnostic and therapeutic efficacy. Direct visualization through cholangiopancreatoscopy may overcome this limitation and allow the resolution of many dilemmas related to the diagnostic and therapeutic drawbacks of ERCP. Herein, we discuss the current indications of single-operator cholangioscopy (SOC) concerning the diagnostic interventions within the biliopancreatic system. The current role of SOC in the diagnosis of pancreatobiliary stenosis, primary sclerosing cholangitis, intraductal papillary mucinous neoplasm, and pre-surgical mapping of neoplastic lesions were reviewed. There is growing data in the literature supporting the early implementation of SOC in the diagnostic algorithm of pancreatobiliary diseases. In selected cases, this could prevent diagnostic delay and reduce the risks and costs related to repeated ERCPs. This potential characterizes SOC as safety and cost-effective.