Intraductal biliopancreatic imaging: European Society of Gastrointestinal Endoscopy (ESGE) technology review

Andrea Tringali; Arnaud Lemmers; Volker Meves; Grischa Terheggen; Jürgen Pohl; Guido Manfredi; Michael Häfner; Guido Costamagna; Jacques Devière; Horst Neuhaus; Fabrice Caillol; Marc Giovannini; Cesare Hassan; Jean-Marc Dumonceau

doi:10.1055/s-0034-1392584

Endoscopy, Table of Contents

Endoscopy 2015; 47(08): 739-753
DOI: 10.1055/s-0034-1392584

Review

Intraductal biliopancreatic imaging: European Society of Gastrointestinal Endoscopy (ESGE) technology review

Authors

Andrea Tringali

¹Digestive Endoscopy Unit, Catholic University, Rome, Italy
Arnaud Lemmers

²Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Brussels, Belgium
Volker Meves

³Department of Gastroenterology and Interventional Endoscopy, Klinikum Friedrichshain, Berlin, Germany
Grischa Terheggen

⁴Department of Internal Medicine, Evangelisches Krankenhaus, Düsseldorf, Germany
Jürgen Pohl

³Department of Gastroenterology and Interventional Endoscopy, Klinikum Friedrichshain, Berlin, Germany
Guido Manfredi

⁵Department of Gastroenterology, Maggiore Hospital, Crema, Italy
Michael Häfner

⁶Department of Internal Medicine, St. Elisabeth Hospital,Vienna, Austria
Guido Costamagna

¹Digestive Endoscopy Unit, Catholic University, Rome, Italy
Jacques Devière

²Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Brussels, Belgium
Horst Neuhaus

⁴Department of Internal Medicine, Evangelisches Krankenhaus, Düsseldorf, Germany
Fabrice Caillol

⁷Endoscopy Unit, Paoli-Calmettes Institute, Marseille, France
Marc Giovannini

⁷Endoscopy Unit, Paoli-Calmettes Institute, Marseille, France
Cesare Hassan

⁸Department of Gastroenterology, Nuovo Regina Margherita Hospital, Rome, Italy
Jean-Marc Dumonceau

⁹Gedyt Endoscopy Center, Buenos Aires, Argentina

Abstract

This technology review expresses the current view of the European Society of Gastrointestinal Endoscopy (ESGE) on the available techniques for intraductal biliopancreatic imaging.

The three cholangioscopy techniques are described: the “dual-operator” and “ single-operator” mother-baby approaches using dedicated instruments, and the “direct” technique using currently available ultrathin gastroscopes.

The mother-baby method is standardized and reproducible, while direct cholangioscopy is technically demanding and its safety requires further evaluation.

As well as direct visualization of the bile ducts, cholangioscopy has the further advantage of allowing targeted biopsy.

Image quality is still suboptimal for single-operator cholangioscopy, while the other techniques have achieved adequately detailed imaging.

The costs of mother-baby cholangioscopy are high and its application in clinical practice should be restricted to selected cases (i.e. indeterminate biliary strictures/intraluminal lesions, difficult biliary stones) and to the setting of tertiary care centers.

Peroral pancreatoscopy may find an indication in situations where other imaging modalities (mainly EUS) are inconclusive (i.e. delineation of main duct intraductal papillary mucinous neoplasia extension, sampling of indeterminate main pancreatic duct strictures)

Intraductal ultrasonography (IDUS) has a poorer performance than EUS in the staging of pancreatic malignancies and can increase the risk of pancreatitis. A promising indication for IDUS could be the evaluation of indeterminate biliary strictures and ampullary tumors.

Probe-based confocal laser endomicroscopy (pCLE) of the bile ducts is a difficult and expensive technique. Appropriate training needs to be established, since interpretation of images is challenging. pCLE can be an important diagnostic tool in the setting of indeterminate biliary strictures.

Full Text

References

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