Overtube-balloon-assisted direct peroral cholangioscopy by using an ultra-slim upper endoscope (with videos)

Gastrointest Endosc. 2009 Apr;69(4):935-40. doi: 10.1016/j.gie.2008.08.043.


Background: The "mother-baby" endoscope system currently used for peroral cholangioscopy (POC) has several limitations. Endoscopic direct cholangioscopy when using an ultra-slim upper endoscope with a guidewire to maintain access has been reported, but appropriate accessories are required to increase the success rate. Herein, we describe a novel method, overtube-balloon-assisted endoscopy, for direct POC.

Objective: To evaluate the feasibility and usefulness of direct POC when using an ultra-slim upper endoscope with an overtube balloon to maintain access.

Setting: A single center.

Design: Case series.

Patients: Twelve patients with biliary disease.

Interventions: Direct POC by using an ultra-slim upper endoscope and diagnostic and/or therapeutic procedures.

Main outcome measurements: Success rate of this technique, diagnostic or therapeutic feasibility, and complications.

Results: Overtube-balloon-assisted direct POC was performed successfully in 10 of 12 patients (83.3%). The procedure revealed 4 common bile duct (CBD) stones, 4 benign biliary strictures, 1 polypoid tumor, and 1 cholangiocarcinoma. Five patients underwent forceps biopsy under direct visualization of the intraductal lesion. Laser lithotripsy was successfully performed in 1 patient. No procedure-related complication occurred.

Limitations: A small number of patients and no comparison with conventional cholangioscopy.

Conclusions: The overtube balloon appears to be a useful accessory in direct POC when using an ultra-slim upper endoscope. However, further development of a slim overtube or other accessories is necessary to improve the success rate of direct POC.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Bile Duct Diseases / diagnosis*
  • Bile Duct Diseases / therapy*
  • Endoscopes, Gastrointestinal*
  • Endoscopy, Digestive System / methods*
  • Equipment Design
  • Female
  • Humans
  • Male
  • Middle Aged
  • Video Recording