Peroral cholangioscopy in the new millennium

Table 1 Comparison of currently available single and dual operator cholangioscopies

	Endoscopists needed	Image quality	Tip deflection	Simultaneous irrigation and instrumentation	Fragility
Single operator (SpyGlass)	One	Moderate - good	4 way (up/down, left/right)	Yes	No1
Dual operator
Fiberoptic cholangioscopies	Two	Moderate - good	2 way (up/down)	No	Yes
Video cholangioscopies	Two	Excellent	2 way (up/down)	No	Yes

¹All components of the spyglass system are single-use with the exception of the spyprobe (the light and image conveyor of the system) which is multi-use. The spyprobe is fragile and has to be handled with care.

Table 2 Common factors associated with failed biliary stone removal during endoscopic retrograde cholangiopancreatography

Patient factors

Abnormal anatomy

Prior surgery

Extremely J-shaped stomach

Large hernias

Malrotations

Unstable or difficult endoscope position

Short duodenal bulb

Abnormal anatomy

Long duodenoscope position

Bile duct abnormalities

Presence of ductal strictures

Severely dilated ducts

Stone factors

Size

Large size

Location

Intrahepatic

Cystic duct

Proximal to strictures

Impacted stones