Direct visualization

Cholangioscopy assisted guidewire placements can be technically successful, especially in cases where conventional ERCP guidewire placement previously failed.¹ 

This technique may also help to avoid more invasive procedures such as percutaneous transhepatic management or endoscopic ultrasound-guided biliary drainage.¹ 

A retrospective study¹…

 …analyzed 167 cholangioscopy procedures for successful guidewire placements across biliary strictures. Only cases with previous failed conventional guidewire placement approaches were included. 

30 cases performed in 23 patients were identified: 

• Post-liver-transplant strictures were the most frequent finding among benign patients (52%) 
• Guidewire placement was successful in 21 of 30 procedures (70%)
• Guidewire placements were significantly more successful in patients with benign strictures
  

A prospective trial²…

 …evaluated the benefit of cholangioscopy following fluoroscopy-guided ERCP for management of biliary complications after liver transplantation in a cohort of 26 patients.

Benefits of cholangioscopy over ERCP were found in 12 of 26 (46,2%) patients: 

• Four successful selective guidewire placements where ERCP attempts had failed
• Three biliary cast and six stones cases not diagnosed by ERCP
• One bile duct ulcer due to fungal infection and one case of inflammation in the bile duct caused by acute cholangitis