ERCP Bootcamp for the Endoscopy Team (Live and Virtual) | December 2023-Overview of Cholangiopancreatoscopy

Video Transcription

Video Summary

Dr. Jessica Widmer discusses the various applications of cholangiopancreatoscopy in the management of stones, assessment of strictures, and treatment of malignancies in the bile and pancreatic ducts. Cholangiopancreatoscopy is performed using the Spyglass single operator cholangioscope, which allows for direct visualization of the ducts and various therapeutic interventions. For stones in the bile and pancreatic ducts, lithotripsy with either electrohydraulic lithotripsy (EHL) or laser lithotripsy is effective in stone clearance. The second generation Spyglass offers better therapeutic options and accessories to improve success rates. When evaluating indeterminate strictures in the ducts, cholangiopancreatoscopy can provide targeted biopsies, improving the sensitivity for diagnosing malignancies and reducing false negative results seen with conventional methods. Additionally, cholangiopancreatoscopy can assist in confirming ductal clearance following stone removal procedures. In terms of therapeutic options for malignant strictures, photodynamic therapy (PDT) and radiofrequency ablation (RFA) are effective treatment modalities for biliary strictures caused by cholangiocarcinoma. Pancreatoscopy can also be used to evaluate main duct intraductal papillary mucinous neoplasms (IPMNs) and assist in preoperative mapping for surgery. The diagnostic role of pancreatoscopy is particularly useful in distinguishing neoplastic from non-neoplastic lesions and guiding targeted biopsies. In the treatment of painful chronic pancreatitis, intraductal lithotripsy with cholangiopancreatoscopy can provide relief by reducing pancreatic duct obstruction. Overall, cholangiopancreatoscopy is a valuable tool in the management of various conditions affecting the bile and pancreatic ducts.

Asset Subtitle

Jessica Widmer, DO, FASGE

Keywords

cholangiopancreatoscopy

stones

strictures

malignancies

bile ducts

pancreatic ducts

lithotripsy