SpyGlass™ DS II Direct Visualization System
SpyGlass™ DS II Direct Visualization System

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Healthcare professionals / Gastroenterology / Advancements in CholangioscopyImage Reference Guide

Cholangioscopy Image Reference Guide

The intent of this reference guide is to help familiarize physicians with the appearance of biliary findings. Images of normal bile, cystic and hepatic ducts are presented to illustrate and familiarize the user with the appearance of a healthy, normal ducts and to contrast with the appearance of the biliary tree in a variety of pathologic states. Images featuring various types of benign and malignant conditions are represented in this guide, including strictures, villous lesions, stone disease, and more.

 
   
normal duct image

Normal Ducts

Throughout the biliary tree, the mucosa has a soft creamy pearly color. Mucosal depressions can be seen which become more apparent in the distal bile duct. They tend to disappear during luminal distention. The vascular pattern is well defined, the vessel contour is crisp and the vascular network is evident. Villous formation is also more noticeable in the distal bile duct. It tends to be uniform, avascular and of short stalk.

  
Mucosal Depressions

Mucosal Depressions

Shallow Depressions

Shallow Depressions

Normal Vascular Pattern

Normal Vascular Pattern

Normal Villous Pattern

Normal Villous Pattern

Normal Common Bile Duct

Normal Common Bile Duct

Normal Cystic Duct Common Bile Duct Junction

Normal Cystic Duct Common Bile Duct Junction

Normal Common Hepatic Duct

Normal Common Hepatic Duct

Normal Deep Left Hepatic Duct

Normal Deep Left Hepatic Duct

Normal Deep Right Hepatic Duct

Normal Deep Right Hepatic Duct

Normal Left Hepatic Duct Hilum

Normal Left Hepatic Duct Hilum

Normal Mucosa

Normal Mucosa

Normal Papillary Area

Normal Papillary Area

Normal Right Hepatic Duct Hilum

Normal Right Hepatic Duct Hilum

Normal Right Hepatic Duct

Normal Right Hepatic Duct

Normal Suprapapillarys

Normal Suprapapillary

   
stone disease benign

Stone Disease (Benign)

The following images provide views of various types of stones and treatment via laser lithotripsy.

  
Cystic Duct Stone

Cystic Duct Stone

Intrahepatic Stone

Intrahepatic Stone

Homium Laser Lithotripsy

Homium Laser Lithotripsy

   
villous lesion image

Villous Lesions (Benign)

The following images depect various types of villous lesions.

  
Villiform Formation

Villiform Formation

Villous Lession

Villous Lession

   
normal duct image

Malignant Strictures

The following images depict various characteristics of malignant strictures.

  
Exophytic Vascular Tissue

Exophytic Vascular Tissue

Characteristics of a Malignant Stricture

Characteristics of a Malignant Stricture

Cholangiocarcinoma Extension

Cholangiocarcinoma Extension

Increased Vascularity

Increased Vascularity

Cholangiocarcinoma STX

Cholangiocarcinoma STX

Vascular Lakes

Vascular Lakes

   
Showing surgical staples image

Filling Defects

Filling defects can be seen throughout the bile duct. They are usually not seen during cholangiography unless extensive (mucin).

  
Filling Defects Showing Surgical Staples

Filling Defects Showing Surgical Staples

Desquamated Epithelium II

Desquamated Epithelium II

Filling Defects Showing Surgical Staples II

Filling Defects Showing Surgical Staples II

Stone Debris

Stone Debris

Desquamated Epithelium

Desquamated Epithelium

   
Biliary Anastamosis Four years

Liver Transplant

The following images show both a donor and native cystic duct post-liver transplant.

  
Biliary anastamosis four years

Biliary Anastamosis Four Years

Biliary anastamosis two years

Biliary Anastamosis Two Years

Biliary Anastamosis Six Months

Biliary Anastamosis Six Months

Native Cystic Duct Biliary Anastamosis Four Years

Native Cystic Duct Biliary Anastamosis Four Years

Biliary Anastamosis 18 Months Intrahepatic Stones

Biliary Anastamosis 18 Months Intrahepatic Stones

   
Epithelial Bridge

Epithelial Bridge

The following images were taken during a procedure that was performed for biliary dilation of uncertain etiology. There was some resistance in advancing SDS around the hilum. An epithelial bridge was noted, which ruptured upon DSD advancement.

  
Epithelial Bridge

Epithelial Bridge

Epithelial Bridge II

Epithelial Bridge II

   
Portal Vein Thrombosis Portal Cholangiopathy

Portal Vein Thrombosis & Cholangiopathy

The following images provide various views of portal vein thrombosis and portal cholangiopathy.

  
Portal_Vein_Thrombosis_Portal_Cholangiopathy

Portal Vein Thrombosis Portal Cholangiopathy

Portal Vein Thrombosis Portal Cholangiopathy IV

Portal Vein Thrombosis Portal Cholangiopathy IV

Portal_Vein_Thrombosis_Portal_Cholangiopathy II

Portal Vein Thrombosis Portal Cholangiopathy II

Portal Vein Thrombosis Portal Cholangiopathy III

Portal Vein Thrombosis Portal Cholangiopathy III

   
Hemobilia image

Hemobilia

In this case, the patient had a bleeding site in the left hepatic duct (LHD), controlled with embolization. In the first branch of the LHD there is a tumor present with associated ulceration.

  
   
   
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