ERCP Bootcamp (On-Demand) | July 2026-Shah_Incorporating cholangioscopy into your practice final

Shah_Incorporating cholangioscopy into your practice final

Pdf Summary

Raj J. Shah’s talk on incorporating cholangioscopy into practice emphasizes that the technology should be used strategically, with strong staff preparation and clear case anticipation. Cholangioscopy is particularly useful for indeterminate biliary strictures, visually directed biopsies, difficult stone therapy, and advanced applications such as pancreatoscopy, foreign body removal, and complete duct obstruction.<br /><br />A major theme is early use in difficult biliary stones, especially large, impacted, barrel- or cuboid-shaped stones, or stones larger than the downstream duct, where standard mechanical lithotripsy may be less effective. For indeterminate strictures, especially proximal/hilar lesions, cholangioscopy improves visualization and targeted sampling; suspicious features include tumor vessels, polypoid or papillary lesions, ulceration, friability, and stenotic-type cholangiocarcinoma.<br /><br />The presentation highlights practical “pearls” for success: give antibiotics when appropriate, obtain a good cholangiogram, clear debris, ensure adequate sphincterotomy or dilation if needed, use gentle scope manipulation, and optimize duodenoscope position for targeting. Device handling tips include using accessories such as baskets, EHL, laser, and forceps appropriately, and recognizing that deflection decreases when devices occupy the working channel.<br /><br />Operationally, staff engagement matters: explain why cholangioscopy is being used, how it will improve efficiency and outcomes, and what tools will be needed. Collaboration helps reduce fatigue and improve procedure flow.<br /><br />The talk also notes broader trends: ERCP/EUS access is becoming concentrated among fewer high-volume providers, reinforcing the need for training pipelines. Future directions include improved ergonomics, durability, and image quality, greater sustainability, and AI-based image analysis for better biliary stricture characterization. Overall, cholangioscopy is presented as a high-value adjunct that can improve diagnosis, therapy, and procedural efficiency when used thoughtfully.

Keywords

cholangioscopy

biliary strictures

indeterminate strictures

difficult bile stones

targeted biopsy

ERCP

pancreatoscopy

mechanical lithotripsy

biliary cholangiocarcinoma

AI image analysis