Introduction:
Cholangioscopy is a method used to examine and treat the problems observed in the body's biliary system. The biliary system is the group of organs and tracts that produce and help transport bile. Cholangioscopy is used to detect blockages in the biliary, liver, and pancreatic ducts, which are difficult to remove.
These blockages are generally due to pancreatic duct stones, gallstones, and bile stones. The cholangioscopy technique can also be used to trace cancers in the ducts and to collect tissue samples for investigations like biopsy. There are different types of cholangioscopy, such as dual-operator mother-daughter per-oral cholangioscopy, single-operator per-oral cholangioscopy, and percutaneous and surgical cholangioscopy.
What Are the Types of Cholangioscopy?
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Dual Operator Mother-Daughter Per-Oral Cholangioscopy: Reusable mother-daughter cholangiocytes contain a control dial for two-way tip deflection and consist of air or water buttons and suction channels. The insertion tube in a cholangioscope consists of an instrument channel, a coherent bundle of glass fibers that helps to transmit the image from the objective lens tip, which is present in the endoscope, to the eyepiece.
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Single-Operator Per-Oral Cholangioscopy: It is a cholangioscopy system with some limitations compared to dual-operator mother-daughter per oral cholangioscopy. The single-operator cholangioscopy is an advanced guidewire into the bile duct through the working channel of the therapeutic duodenoscope.
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Ultraslim Endoscopes: These endoscopes are directly inserted into the bile or pancreatic duct at the time of a standard upper endoscopy.
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Surgical and Percutaneous Cholangioscopy: These fiber optic cholangioscopes have a larger diameter which allows a larger number of optical fibers, which leads to better illumination, field of vision, and good image resolution. These optic fibers are inserted into the biliary tree by a mature percutaneous route or during surgery. The images are then converted from fiber optic to a video format by a separate eyepiece.
Who All Need Cholangioscopy?
Cholangioscopy is generally recommended for people who have a blockage in their duct or strictures (narrowed duct). However, some cases may need cholangioscopy. They are:
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Bile Duct Infections or Blockages: Infection or blockage in the bile duct is known as cholangitis. The cause of cholangitis is inflammation of the bile duct, generally due to bacterial infection.
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Pancreatic Duct Stones or Biliary Duct Stones: To evaluate the ducts blocked by the stones, endoscopes can be used, and in some cases, sound waves are also used to break a bile stone into simpler pieces. This procedure is known as lithotripsy.
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Duct Strictures: Cholangioscopy tools can widen the narrow bile duct to allow proper flow of bile or insert a stent. A stent is a hollow tube inserted into the duct to hold the duct open. Duct strictures also include primary sclerosing cholangitis.
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Pancreatitis: Inflammation caused in the pancreas leads to pancreatitis, which may need cholangioscopy to trace the inflammation.
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Cholangiocarcinoma: Cancer in the bile duct is known as cholangiocarcinoma. In such cases, cholangioscopy helps to investigate the details of the malignant lesion and helps to collect better samples for biopsy tests of the lesion.
How to Prepare for Cholangioscopy?
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It is important to inform doctors about all the patient's medications and supplements.
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If the patient is suffering from an allergy, they should be informed by the doctor before starting the procedure of cholangioscopy.
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The patient is asked to stop eating at least 8 to 12 hours before the cholangioscopy.
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Doctors may prescribe antibiotics before the procedure of cholangioscopy.
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The patient should not come alone for the procedure of cholangioscopy as the technique requires sedation, which may make it difficult for the patient to go back home alone.
How Is the Procedure of Cholangioscopy Performed?
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The first step in the process of cholangioscopy is the administration of anesthesia by the anesthesiologist. This makes the patient drowsy and comfortable for the procedure.
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Numbing agents are applied to the throat, so the patient does not get gag or experience choking during the procedure.
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A mouthpiece is placed between the teeth to protect the mouth, and the endoscope does not interfere with breathing.
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The doctor then guides the endoscope through the mouth and stomach into the biliary system.
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The endoscope inside will be used to evaluate the biliary, liver, and pancreatic ducts for spotting the blockage or any other issue like inflammation or cancer.
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At last, with the help of suitable instruments, the doctor either breaks down the bile stones if present or collects tissue for biopsy investigation to check for malignancy.
What Happens After Cholangioscopy?
After the test, the patient is kept in the recovery room until the effects of sedatives end, and then the doctor discusses the results of the cholangioscopy. The patient is given further instructions depending on the procedures performed during the cholangioscopy.
What Are the Side Effects of Cholangioscopy?
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Sore throat due to insertion of the endoscope. Lozenges can cure this.
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Side effects due to sedatives include vomiting, drowsiness, and an upset stomach.
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The doctors blow little air during the procedure for the proper vision of the organs, which may lead to intestinal gas and bloating in the stomach.
Conclusion:
Cholangioscopy is a diagnostic and treatment procedure that helps to investigate the biliary and pancreatic duct, gallbladder, and liver. The procedure collects tissue samples in cases of infections, inflammation, and malignancy in the bile duct, pancreatic duct, gallbladder, and liver. Cholangioscopy is also used to widen the narrow ducts or strictures and break down gallstones in the biliary and pancreatic ducts. The cholangioscopy procedure is very effective in treating and diagnosing the conditions of organs that help to produce and transfer bile. There are minimal side effects of the procedure; it is easy and performed in a less invasive technique.
