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Intraductal endoscopy (cholangioscopy) - Cholangioscopy is the examination of the bile ducts with the use of a fiberoptic endoscope for direct visualization of the biliary tree during ERCP (endoscopic retrograde cholangiopancreatography).

Developed in 1961, cholangioscopy (also known as intraductal endoscopy) is the examination of the bile ducts with the use of a fiberoptic endoscope for direct visualization of the biliary tree during an ERCP (Endoscopic Retrograde Cholangiopancreatography). A physician may choose to perform a cholangioscopy in the event that x-ray imaging from an ERCP is insufficient to make an adequate diagnosis, or therapeutic intervention requires direct visualization.

A conventional cholangioscopy procedure requires two endoscopists - one to operate the duodenoscope and a second to steer the cholangioscope and operate its working channel. The fragility of the optical fibers, and less invasive methods like ultrasound and CT, contributed to its decreased use. Peroral cholangioscopy (POCS) was not used in the diagnosis of biliary disease as a result of these technological difficulties.

illustration, photos The SpyGlass™ Direct Visualization System is one of the latest advancements in intraductal visualization during a cholangioscopy. The SpyGlass System is the first single-operator intraductal system that allows not only optical viewing, but also optically guided biopsies. The SpyGlass System is designed to allow the physician the ability to directly see the site of interest - whether it be a stricture, stones or an area of concern - vs. traditional non-direct visualization techniques such as x-ray.

Cholangioscopy with the SpyGlass System is performed by a single operator with the SpyScope® Access and Delivery Catheter, which is positioned just below the operating channel of the duodenoscope. This allows the endoscopist to control both the tip deflection wheels of the duodenoscope and the knobs of the SpyScope Catheter with the same hand. The physician's other hand holds the duodenoscope, which is inserted into the patient's mouth and navigated through the anatomy to a position in front of the papilla where a sphincterotomy may be performed as necessary.

image from Boston Scientific, demonstrating SpyGlass SpyScope technology

At this point, the SpyGlass Probe is introduced into the SpyScope Access and Delivery Catheter where the bile duct is cannulated, and the SpyScope Catheter guides the SpyGlass Probe into the biliary tree. The SpyScope Catheter and SpyGlass Probe are maneuvered up to the desired area of interest within the duct for direct visualization. Additionally, selected ducts and branches of interest can be examined during repeated advancement and withdrawal of the system utilizing the four-way tip deflection. Two separate channels in the SpyScope Catheter allow for adequate irrigation to clear debris and aid in providing therapy to the area. If necessary, the SpyBite® Biopsy Forceps, guided by the SpyScope Catheter, are introduced and an optically guided biopsy can be taken.

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