Cholangioscopy with intraductal lithotripsy has become an established modality in the treatment of difficult biliary stones. When used in the evaluation of indeterminate biliary strictures by endoscopists experienced in recognizing intraductal conditions, it increases the diagnostic yield of tissue sampling. Pancreatoscopy is complementary to other imaging modalities in the evaluation of IPMN and remains investigational in the diagnosis of pancreatic adenocarcinoma and the treatment of pancreatic duct stones. Because of lower morbidity rates, the per oral approach is preferred over the percutaneous route for both intraductal lithotripsy and tissue sampling and can be performed at the time of the initial ERCP. The percutaneous approach should be reserved for targeting inaccessible intrahepatic stones and strictures. Until cholangioscopy becomes technically less demanding, cholangioscopes more durable, and an appropriate billing code for per oral cholangioscopy is established, cholangiopancreatoscopy will likely continue to be limited to referral centers.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging