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Balloon catheter cannulation for route identification and axis stabilization during direct freehand cholangioscopy

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Freehand techniques for direct cholangioscopy access have received little attention, given disappointing initial results and high perceived and/or real technical challenges. However, while pure freehand intubation appears feasible in a significant proportion of individuals, technical advance-ments and tricks of the trade are being developed. Along these lines, herein I present another rescue technique assisting in freehand access for direct cholangioscopy, the “balloon-catheter-cannulation technique”, which may be instrumental in overcoming two major hurdles of the procedure, i.e., stable intubation of the papillary orifice with adequate orientation and scope advancement in the common bile duct vis-à-vis gastric loop formation. To further disseminate direct cholangioscopy in the endoscopy community, technical beyond technological advancements, as for instance dedicated next-generation cholangioscopes, appear essential. Herein, I present a technical case report focussing on the limitations of the pure freehand and relative advantages of the “balloon catheter cannulation-assisted” approach for direct cholangioscopy access.

Abstract

Freehand techniques for direct cholangioscopy access have received little attention, given disappointing initial results and high perceived and/or real technical challenges. However, while pure freehand intubation appears feasible in a significant proportion of individuals, technical advance-ments and tricks of the trade are being developed. Along these lines, herein I present another rescue technique assisting in freehand access for direct cholangioscopy, the “balloon-catheter-cannulation technique”, which may be instrumental in overcoming two major hurdles of the procedure, i.e., stable intubation of the papillary orifice with adequate orientation and scope advancement in the common bile duct vis-à-vis gastric loop formation. To further disseminate direct cholangioscopy in the endoscopy community, technical beyond technological advancements, as for instance dedicated next-generation cholangioscopes, appear essential. Herein, I present a technical case report focussing on the limitations of the pure freehand and relative advantages of the “balloon catheter cannulation-assisted” approach for direct cholangioscopy access.

참고문헌 (11)

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  2. Brauer BC, "Single-step direct cholangioscopy by freehand intubation using standard endoscopes for diagnosis and therapy of biliary diseases", Am J Gastroenterol, 107, pp.1030~1035 (2012)
  3. Zimmer V, "A “tandem approach” using sequential diagnostic (ultraslim)and therapeutic (standard size) direct freehand cholangioscopy to guide mechanical lithotripsy of a giant cystic duct remnant stone", Endoscopy, 49, pp.E160~E162 (2017)
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  6. Zimmer V, "Re-purposed use of a stiffening wire as a novel adjunct for direct cholangioscopy access", Endoscopy, 49, pp.1118~1119 (2017)
  7. Huang YH, "A snare-assisted peroral direct choledochoscopy and pancreatoscopy using an ultra-slim upper endoscope : a case series study", Dig Liver Dis, 49, pp.657~663 (2017)
  8. Donatelli G, "Revision of biliary sphincterotomy by re-cut, balloon dilation or temporary stenting: comparison of clinical outcome and complication rate (with video)", Endosc Int Open, 5, pp.E395~E401 (2017)
  9. Zimmer V., "Knock-knock-knockin’ on bile duct’s door: the “tip-of-the-biopsyforceps technique” - probing the route during freehand-intubated direct cholangioscopy", Endoscopy, 49, pp.E153~E154 (2017)
  10. Zimmer V, "Novel biopsy forceps anchoring technique for completion of direct cholangioscopy after freehand intubation", Dig Endosc, 29, pp.638~639 (2017)
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