Current Status and Future Perspective in Cholangiopancreatoscopy.

PURPOSE OF REVIEW

With the rapid growth of cholangiopancreatoscopy, several platforms of cholangiopancreatoscopy have been currently available. Since the introduction of digital single-operator cholangiopancreatoscopy, there have been several reports describing its efficacy for long-standing and novel applications. The purpose of this review is to show the current status and future perspective of cholangiopancreatoscopy.

RECENT FINDINGS

Meta-analysis of cholangiopancreatoscopy have demonstrated good diagnostic yield for visual impression; however, it should be noted that there is no standardized classification system used for distinguishing benign from malignant lesions. In contrast, utility of tissue sampling under direct vision for cholangiopancreatic disorders is inconclusive. This could be explained by the fact that available devices (e.g., biopsy forceps) are limited by the small diameter of accessory channel. Regarding therapeutic applications, several studies demonstrated efficacy and feasibility of electrohydraulic lithotripsy or laser lithotripsy for difficult bile duct stone and pancreatic duct stone under cholangiopancreatoscopic guidance. Additionally, ablation of tumors, selective guidewire placement, retrieval of migrated stents, and anterograde cholangioscopy-guided procedure by using cholangiopancreatoscopy have been reported. The recent development of digital single-operator cholangiopancreatoscopy enables easy access to the bile duct and pancreatic duct, contributing to expanding indications for cholangiopancreatoscopy. Improvement of devices or development of innovative devices is required to overcome the remaining problems of cholangiopancreatoscopy.