Can image-enhanced cholangioscopy distinguish benign from malignant lesions in the biliary duct?

Best Pract Res Clin Gastroenterol. 2015 Aug;29(4):611-25. doi: 10.1016/j.bpg.2015.05.007. Epub 2015 Jun 9.


A new video peroral cholangioscopy (POCS) has been developed with high-quality digital imaging, and its clinical use has been reported. Additionally, direct peroral cholangioscopy (D-POCS) using an ultraslim endoscope has been proposed recently. To improve the diagnostic yield of POCS or D-POCS, image-enhanced endoscopy has been used in combination. Chromoendoscopy with methylene blue staining (ME), autofluorescence imaging (AFI), and narrow-band imaging (NBI) has been evaluated in biliary tract diseases. Observation of the mucosal structure and vessels is reportedly important for distinguishing non-neoplasms from neoplasms. Therefore, NBI is the most promising tool among image-enhanced endoscopies as it can enhance visualization of the mucosal structure and vessels simultaneously. There are currently few reports that have evaluated the utility of POCS or D-POCS based on pathological findings. Thus, endoscopic findings of the bile duct mucosa have not yet been fully established. At present, POCS-guided biopsy should be carried out.

Keywords: Autofluorescence imaging; Cholangioscopy; Image-enhanced endoscopy; Methylene blue staining; Narrow-band imaging.

Publication types

  • Review

MeSH terms

  • Bile Ducts / pathology*
  • Biliary Tract Diseases / diagnosis*
  • Cholangiopancreatography, Endoscopic Retrograde / instrumentation*
  • Humans
  • Image Enhancement*
  • Methylene Blue / metabolism
  • Optical Imaging
  • Staining and Labeling / methods


  • Methylene Blue