ERCP and Cholangioscopy: Changing Role in Biliary Diseases

The traditional mother-daughter system employs a duodenoscope that allows a baby cholangioscope (Fig. 1) to pass through its large instrument channel into the bile duct. This usually requires a sphincterotomy or sphincteroplasty to allow biliary access with the cholangioscope. Two endoscopists are typically required for this procedure, which is limited by the extreme fragility of the cholangioscope. There are various external dimensions of the commercially available cholangioscopes, although the latest scopes are roughly 10 Fr in diameter. Recently, the partly disposable SpyGlass® system was introduced (Fig. 2). This is a single-operator platform that also uses a mother-daughter design. A disposable 10 Fr spy scope has two working channels. One channel takes a fiber optic probe for visualization, the second accommodates a device (such as lithotripsy probe or biopsy forceps) (Fig. 3, 4).