Key cho seo spyglass12/28/2023 6 The SpyGlass semi-disposable direct visualization system was first introduced in 2005 and it overcame a number of disadvantages posed by the mother and baby systems. The baby scopes today have image enhancing capabilities (narrow band imaging or NBI) which have augmented the ability to differentiate benign from malignant lesions. With the introduction of video-endoscopes, the image quality has improved significantly. 5 The initial procedures were hampered by technical limitations like poor image quality, small instrumentation channel limiting therapy, lack of tip deflection and air and water irrigation channels. Urakami et al carried out the first direct per-oral cholangioscopy using a straight-view endoscope. This “mother and baby scope” approach is still the most commonly used cholangioscopic technique. 2 – 4 The initial procedures were carried out using a smaller scope (baby scope) inserted through the instrumentation channel of a large channel therapeutic duodenoscope (mother scope). The feasibility of percutaneous approach was first demonstrated in 1974 and per-oral approach simultaneously by two different teams in 1976. This brief review will highlight the historical developments, currently available per-oral cholangioscopic equipment and techniques, indications and future prospects of this procedure.Ĭholangioscopy was first introduced in the 1970s. The bile duct can now be accessed percutaneously and per-orally or intra-operatively via a choledochotomy or the cystic duct. The idea of direct visualization of the bile duct (cholangioscopy) has allured the gastroenterologist for more than a couple of decades now. However, ERCP guided cytology and biopsy has at best, modest sensitivity in diagnosing malignant lesions. 1 ERCP can outline the anatomy of the biliary tree and define any strictures or filling defects. With the advent of safe and advanced pancreato-biliary imaging techniques like computed tomography (CT) scan, magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound (EUS), the use of diagnostic ERCP has decreased significantly. The first endoscopic retrograde cholangio-pancreatography (ERCP) was performed more than three decades ago and it has continued to evolve ever since.
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