Peroral Cholangioscopy in the Diagnosis and Treatment of Biliary Strictures

Objective: To determine the role of and indications for peroral cholangioscopy using the SpyGlass system in the differential diagnosis of biliary tract lesions and in case of biliary strictures, based on the literature data analysis and our own experience.

Materials and methods: Peroral cholangioscopy is mainly used for the differential diagnosis of biliary tract lesions. During peroral cholangioscopy, we carefully consider gross signs of damage to the bile duct mucosa: abnormal capillary vascular pattern, granulation tissue and other types of proliferation, palpatory characteristics of the wall. Morphology should also be verified during image-guided intraductal forceps biopsy.

Results: Peroral endoscopy of the biliary tract significantly increases the effectiveness of differential diagnosis between various types of biliary strictures.

Direct examination of the bile duct mucosa with optical forceps biopsy and morphological verification increases the sensitivity and specificity of stricture type determination up to 83.3%–96% and 90.9%–99%, respectively. The diagnostic value of peroral cholangioscopy in the diagnosis of malignant and benign biliary tract lesions exceeds the effectiveness of endoscopic retrograde cholangiopancreatography, even with fluoroscopy-guided verification of ducts.

Conclusions: Peroral cholangioscopy with its enormous potential plays an important role in management of patients with various diseases of the bilio-pancreatoduodenal area, including biliary strictures. We formulated key indications for peroral cholangioscopy based on the literature data analysis and our own experience with this technique in patients with bile duct pathology, including nondifferentiated biliary strictures.

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