Percutaneous single-operator video cholangioscopy using a novel short disposable endoscope: first clinical case with treatment of a complex biliary stone and inaccessible papilla after Roux-en-Y reconstructive surgery

ERCP is technically challenging and time consuming in patients with surgically altered upper GI anatomy, particular after Roux-en-Y reconstruction. A conventional endoscopic approach using side-viewing duodenoscopes frequently fails, an enteroscopy-assisted technique has to be performed. However, the efficacy of therapeutic interventions via enteroscopic route usually limited.1Ayoub F. Brar T.S. Banerjee D. et al.Laparoscopy-assisted versus retrograde cholangiopancreatography (ERCP) gastric bypass: a meta-analysis.Endosc Int Open. 2020; 8: E423-E436Crossref PubMed Google Scholar, 2Shah R.J. Smolkin M. Yen R. al.A multicenter, U.S. experience single-balloon, double-balloon, rotational overtube-assisted enteroscopy pancreaticobiliary anatomy (with video).Gastrointest Endosc. 2013; 77: 593-600Abstract Full Text PDF Scopus (186) 3Skinner Popa Neumann H. al.ERCP technique: systematic review.Endoscopy. 2014; 46: 560-572Crossref (155) Scholar Direct cholangioscopy emerged as cornerstone evaluation indeterminate biliary strictures treatment for complex stones.4Bokemeyer A. Gerges C. Lang al.Digital single-operator video treating refractory stones: multicenter observational study.Surg 34: 1914-1922Crossref (18) 5Gerges Beyna T. Tang R.S.Y. peroral cholangioscopy-guided biopsy sampling ERCP-guided brushing strictures: prospective, randomized, trial 91: 1105-1113Abstract (51) 6Tringali Lemmers Meves V. al.Intraductal biliopancreatic imaging: European Society Gastrointestinal Endoscopy (ESGE) technology 2015; 47: 739-753Crossref (71) Currently, no system on market can used approach. Thus, these situations require percutaneous insertion endoscope into bile duct system.7Ahmed S. Schlachter T.R. Hong K. Percutaneous transhepatic cholangioscopy.Tech Vasc Interv Radiol. 18: 201-209Abstract (30) Scholar,8Tsutsumi Kato Yabe comparative methods stones hepaticojejunostomy between peroral, short double-balloon enteroscopy.Therap Adv Gastroenterol. 2017; 10: 54-67Crossref (11) The first step always establish access; this done either by interventional endoscopist or radiologist, depending local expertise policy. second series bougination sessions, until mature stable access achieved. Traditionally, aside from bronchioscopes, dedicated cholangioscopes are used. some critical drawbacks.9Choi J.H. Lee S.K. cholangioscopy: does its role still exist?.Clin 529-536Crossref (19) First, reprocessable endoscopes cannot totally sterilized thus prone risk infection cases unrecognized contamination. Second, minimum diameter around 5 mm, implying long-lasting sequential tract at least 16F within 3 4 sessions. Third, bronchioscopes offer only 2-way deflection, which substantially limits their maneuverability capability performing interventions. Since 2015, digital videocholangioscopy (SOVC) been available transpapillary direct cholangioscopy. Its benefits intraluminal therapy difficult-to-treat pancreatic have studied clinical trials.5Gerges Scholar,10Navaneethan U. Hasan M.K. Kommaraju al.Digital, cholangiopancreatoscopy diagnosis management pancreatobiliary disorders: 2016; 84: 649-655Abstract Scholar,11Gerges Pullmann Bahin al.SpyGlass DS-guided lithotripsy symptomatic treatment-refractory chronic calcifying pancreatitis.Endosc 2019; 7: E99-E103Crossref Case reports shown that device also tool access, although it was formally built long over accessory channel standard duodenoscope.12Peck J.R. Spain J. Al Taani al.Percutaneous antegrade disorders.VideoGIE. 2: 145-146Abstract (3) 13Trikudanathan G. Singh Shrestha P. intraductal electrohydraulic choledocholithiasis inaccessible papilla.VideoGIE. 152-154Abstract 14Hubers Patel Dalvie patient complicating benign stricture.VideoGIE. 4: 423-425Abstract 15Fujii Y. Koshita Ito SpyGlassDS anastomotic stenosis choledochojejunostomy.Dig 2018; 30: 806-807Crossref (4) offers advantages reusable endoscopes. SOVC itself 10.5F, reducing target 11F. manufactured delivered sterile package, minimizes endoscope-transmitted infections. 4-way deflection capabilities allow excellent system. limitation is, course, smaller 1.2 mm diameter. forceps 1.9F probe available. Finally, length original use daily practice. We report here case novel system, specifically designed access. Not maintain all aforementioned advantages, but catheter (65 cm) further improves endoscope’s tip improved handling owing shorter (Fig. 1). 63-year-old man referred another institution obstructive jaundice severe cholangitis complicated cholangiosepsis. MRCP revealed large, obstructing stone common duodenum-preserving head resection pancreatitis 2 years earlier.16Frey C.F. Amikura Local pancreas combined longitudinal pancreaticojejunostomy pancreatitis.Ann Surg. 1994; 220 (discussion 7): 492-504Crossref (259) underwent curative right hemicolectomy colonic cancer 1 year later. He had recovery, resulting multiple adhesions need emergency surgery acute small-bowel obstruction months before presentation. This may why previous device-assisted failed. drainage our institution, leading quick stabilization. Two sessions wire-guided sinus were needed achieve soft Yamakawa implanted temporary internal drainage. interval weeks maturation fistula, performed 2), successful fragmentation under vision. Most fragments pushed duodenum continuous irrigation 3; Video 1, online www.VideoGIE.org). small remaining percutaneously extracted vision dormia extraction basket. After documentation complete clearance, implantation needed.Figure 3A, Cholangioscopic visualization large proximal working channel. B, Effective achieved.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Novel promises useful addendum armamentarium options selected hepatobiliary diseases