Visualized biliary cannulation during ERCP: future trends

We are honored to see Dr. Li Liu and colleagues' interest [1] in our work on visualized biliary cannulation technology during endoscopic retrograde cholangiopancreatography (ERCP) [2], and would like to respond to some of the questions raised.

First, the invention of the traditional ERCP technique was based on the absence of cholangioscopy 50 years ago. After decades of development, although skilled specialists have a high rate of successful intubation, ERCP is still the most challenging procedure for beginners. The ultimate aim of our technology is to increase the intubation success rates, especially for beginners, by clarifying the 3D inner structure of the major papilla.

The original aim of our study was to investigate the feasibility of this technique. In order to ensure patient safety, patients with relatively simple choledochal stones were included in the study and the procedures were performed by experienced operators. We believe that the endoscopic retrograde direct cholangioscopy (ERDC) technology should be less difficult to learn than traditional ERCP, because the transparent cap provides some support and allows direct clarification of the internal structure of the major papilla. More interestingly, we have found that the bile duct and pancreatic duct openings have different anatomical structures. More studies need to be conducted to clarify why there are different openings, which may help to understand the pathogenesis of some biliopancreatic system diseases. In addition, the ERDC technology may have higher diagnostic value for some early bile duct and papillary tumors.

Compared with conventional ERCP, the ERDC technology does require one practitioner and one assistant. Once the operation-related strategy is more mature, we believe that the intubation procedure is significantly better than that of conventional ERCP, although this needs to be confirmed by more randomized controlled trials.

ERDC is so far unable to replace ERCP, but we strongly believe that, with improvement of the technology, there will be more indications for its use in the future.

Publication History

Article published online:
27 June 2024

• References

• 1 Wang J, Fan Z, Liu L. Visualized biliary cannulation during ERCP: do we really need it?. Endoscopy DOI: 10.1055/a-2234-8599.
• 2 Liu WH, Huang XY, Hu X. et al. Initial experience in visualized biliary cannulation during ERCP. Endoscopy 2023; 55: 1037-1042