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Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Dec 16, 2021; 13(12): 571-592
Published online Dec 16, 2021. doi: 10.4253/wjge.v13.i12.571
Choledochoscopy: An update
Tsinrong Lee, Thomas Zheng Jie Teng, Vishal G Shelat
Tsinrong Lee, Thomas Zheng Jie Teng, Vishal G Shelat, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
Vishal G Shelat, Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
Author contributions: Lee T, Teng TZJ and Shelat VG contributed to this paper; Shelat VG designed the overall concept and supervised the writing of the manuscript; Lee T, Teng TZJ and Shelat VG contributed to the writing and editing of the manuscript.
Conflict-of-interest statement: The authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tsinrong Lee, Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore 308232, Singapore. leet0043@e.ntu.edu.sg
Received: March 20, 2021
Peer-review started: March 20, 2021
First decision: July 17, 2021
Revised: July 23, 2021
Accepted: November 15, 2021
Article in press: November 15, 2021
Published online: December 16, 2021
Abstract

Choledochoscopy, or cholangioscopy, is an endoscopic procedure for direct visualization within the biliary tract for diagnostic or therapeutic purposes. Since its conception in 1879, many variations and improvements are made to ensure relevance in diagnosing and managing a range of intrahepatic and extrahepatic biliary pathologies. This ranges from improved visual impression and optical guided biopsies of indeterminate biliary strictures and clinically indistinguishable pathologies to therapeutic uses in stone fragmentation and other ablative therapies. Furthermore, with the evolving understanding of biliary disorders, there are significant innovative ideas and techniques to fill this void, such as nuanced instances of biliary stenting and retrieving migrated ductal stents. With this in mind, we present a review of the current advancements in choledo-choscopy with new supporting evidence that further delineates the role of choledochoscopy in various diagnostic and therapeutic interventions, complications, limitations and put forth areas for further study.

Keywords: Choledochoscopy, Cholangioscopy, Indeterminate biliary strictures, Difficult bile stones, Primary sclerosing cholangitis, Cholangiocarcinoma

Core Tip: The role of choledochoscopy (for extrahepatic biliary procedures) and cholangioscopy (for intrahepatic biliary procedures) is one and a half centuries old. It is a reliable tool in the visualization of indeterminate strictures and subsequent biopsy for diagnostic purposes. Furthermore, it serves as the “safety net” in therapeutic measures where endoscopic retrograde cholangiopancreatography cannot manage, such as biliary stone fragmentation and retrieving migrated equipment. With the advent of new techniques and adjuncts, its potential has further evolved to improve the procedure's accuracy. We provide a comprehensive update on the current and future potential of choledochoscopy.