Save powerpoint presentations as pdf files office support. In this context, cholangioscopy was introduced in order to improve diagnostic and therapy of biliary diseases, allow ing direct visualization of. Under print quality paper pdf, set the desired quality to an option of your choice. Peroral cholangioscopy overcomes some of the limitations of endoscopic retrograde cholangiopancreatography ercp. The spyglass direct visualisation system for diagnostic. Accurate diagnosis of indeterminate biliary lesions is essential for treatment planning. Pdf converter is a online webbased document to pdf converter software. For cholangioscopyassisted biopsy cab, the target biopsy site was localized by using cp visualization and a. Xray films are taken at 10minute intervals as the dye is excreted via the cystic, hepatic, and common bile ducts.
The spyglass is a singleoperator cholangioscopy system designed to overcome the limitations of the standard motherbaby cholangioscopy procedure. The standards of practice committee of the american society for gastrointestinal endoscopy asge. Ppt cholangiocarcinoma powerpoint presentation free to. Spyglass d i r e c t v i s u a l i z at i o n s y s t e m bostonscientificcorporation onebostonscientificplace natick,ma017601537. Pdf nowadays, cholangioscopy is an established modality in diagnostic and treatment of pancreaticobiliary diseases. The following addon code may be used to report cholangioscopy procedures using the spyglass direct visualization system. Cholangiopancreatoscopy cp enables direct endoscopic visualization of the biliary and pancreatic ductal systems. The feasibility of percutaneous approach was first demonstrated in 1974 and peroral approach simultaneously by two different teams in 1976. The safety and scientific validity of this study is the responsibility of the study sponsor and investigators.
Is there a role for cholangioscopy in patients with. Follow these instructions to set the print quality of the pdf. The segment of abdominal imaging is subsegmented into percutaneous transhepatic cholangiography ptc, magnetic resonance cholangiopancreatography mrcp, endoscopic retrograde cholangiopancreatography ercp, and others. Direct peroral cholangioscopy by using an ultraslim upper. Rendezvous biliary recanalization of complete biliary.
With advances in endoscopic and imaging technology, cholangioscopy has become an. The benefits of direct visualization cholangioscopy are well known and documented but traditional approaches limited adoption due to the need for two. Cdb was performed by using a miniature cholangioscope biopsy forceps olympus under direct endoscopic visualization. The role of endoscopy in the evaluation and treatment of. Direct peroral cholangioscopy by using an ultraslim upper endoscope. Cholangioscopy is a helpful tool in the evaluation of biliary disorders, with indeterminate biliary strictures and large bile duct stones being the most common indications. Several authors, described the feasibility and e ectiveness of this technique. Cholangioscopy originated as an intraoperative procedure, performed for the localization of stones during common bile duct exploration. The aim of this retrospective study was to evaluate the diagnostic accuracy of spyglass. Endoscopy has an established role in the diagnosis and therapy of biliary strictures. Advances in cholangioscope technology have led to improvements in visualization and scope maneuverability. Ercpcholangioscopy colonoscopy capsule endoscopydbe digital flexible endoscopes. Pdf the safety and efficacy of singleoperator cholangioscopy in.
Ppt cholangioscopy powerpoint presentation, free download id. In the powerpoint preferences dialog box, click general. What cpt code should i use to report the new spyglass visualization system. Although ultraslim pediatric or tran nasal video endoscopes are usually used for the direct peroral video cholangioscopy, direct scope insertion without pretreatment and any assistant is. A number of case studies have described the usefulness of peroral cholangioscopy for diagnosis and therapy, performed by visualizing the inner cavity of the bile duct.
The choice of stent palliati should individualized. Pdf direct examination of the biliary tree with endoscopes has been a challenge since endoscopists began performing endoscopic. Cholangiography definition of cholangiography by medical. Review article advances in therapeutic cholangioscopy.
Cholangioscopy allows direct and optical contrast based nbi visualization of the biliary tree particularly useful for assessing strictures and treating large stones and confirming their complete removal role in assessing postolt biliary strictures. Peroral cholangioscopy is traditionally only conducted using a. The diagnosis of biliary strictures can be challenging. New advancements in cholangioscopy is providing clearer imaging for diagnosis. Spyglass singleoperator peroral cholangioscopy system has been developed to overcome these limitations. Anastomotic biliary strictures after liver transplantation remain one of the major cause of morbidity and mortality. The biliary tree is among the most elusive structures for endoscopic observation. The more widespread use and the recent development of new technologies and accessories had renewed the interest of endoscopic visualization of the biliary tract, increasing the range of indications and therapeutic procedures, such as diagnostic of indeterminate biliary strictures. Approach to management of indeterminate biliary stricture. Gi what is the code for cholangioscopy with biopsy in the bile duct. Cholangioscopy definition of cholangioscopy by medical.
The role of endoscopy in the evaluation and treatment of patients with biliary neoplasia this is one of a series of statements discussing the use of gi endoscopy in common clinical situations. Cholangiocarcinoma is the property of its rightful owner. Currently available types of peroral cholangioscopy include peroral videocholangioscopy pocs using a motherbaby scope system mbss, direct peroral videocholangioscopy dpocs, and spyglass direct visualization. Cholangiography, percutaneous transhepatic daviss lab. Percutaneous transhepatic cholangioscopy and palliative photodynamic therapy of a cholangiocellular carcinoma klatskin tumor j herzog and a eickhoff, klinikum hanau, hanau, germany r20 elsevier gmbh. Subsequently, a singleoperator fiberoptic cholangioscope. Listing a study does not mean it has been evaluated by the u. In the intravenous method, the dye is administered intravenously and is excreted by the liver into the bile ducts. Distal cholangiocarcinoma treated with pancreaticoduodenectomy a pyloruspreserving operation is preferable and feasible 5yr survival rates 23% 50% 62% in pts undergone complete resection of a node negative tumor murakami y et al.
Convert and create pdf from various types of files like word doc, excel xls, powerpoint ppt. Cholangioscopy provides an opportunity to directly visualize the bile duct for diagnosing biliary lesions and. Instantly convert text documents, presentations, spreadsheets and images to pdf format with this free online pdf converter. Cholangioscopy is an established modality for the management of large biliary stones, the diagnosis and exclusion of biliary tumors, and for the evaluation of indeterminate biliary strictures. An overview of the evolution of direct cholangioscopy. American journal of gastroenterology issn 00029270 c 2006 by am. Usg abdomen suggestive of gall bladder stones with a. Usefulness of cholangioscopy in patients with focal stricture of the intrahepatic duct unrelated to intrahepatic stones. No role for brush cytology, ductal biopsy, cholangioscopy, orconfocal laser endomicroscopy. Percutaneous transhepatic cholangiography technique. Cholangioscopy is most frequently used during ercp.
The reported incidence of biliary strictures ranges between 16% and 32%. The following is an overview of the currently available peroral cholangioscopy equipments, indications for use and future directions. Cholangioscopy was subsequently used as an adjunct technique during percutaneous. Recent advances in gastrointestinal endoscopy sammy ho, md director of pancreaticobiliary services and endoscopic ultrasound director of advanced endoscopy fellowship montefiore medical center. He was re ferred to our unit for further cholangioscopic characteri sation using single operator peroral cholangioscopy. Siegel, md, rph keywords motherdaughter system, percutaneous endoscopic extraction of retained stones, skinnyneedle percu. Cholangioscopy allows direct visualization and subsequent therapeutic maneuvers of the biliary ductal system.
Endoscopic treatment relies on initial passage of a guidewire across the stricture, followed by subsequent. Overall success rates for adequate tissue sampling and bile duct stone clearance averages to 90%. Cholangioscopy can provide endoscopic direct visualization of the biliary system. However, the diagnostic yield from conventional endoscopic retrograde cholangiopancreatography tissue sampling is modest. After the inner stylet is withdrawn, contrast material is injected while the needle is retracted.
Improvements in existing technologies as well as the implementation of novel technologies and techniques have the potential to. Mouen khashab, who specializes in therapeutic endoscopy at johns hopkins, discusses the new era of cholangioscopy, including when it is used, how it differs from prior devices and the advantages of using it over other therapies. Common bile duct cbd stones are extracted with a basket. Endoscopic retrograde cholangiopancreatography or ercp is a test used to study the biliary system, which includes the liver, gallbladder and pancreas. Percutaneous transhepatic cholangioscopy and palliative.
Deepak agrawal md university texas southwestern parkland hospital. A cholangioscopy procedure, when used in conjunction with ercp, allows a more detailed visual examination by passing a small, optical camera through the endoscope. Cholangiocarcinoma ppt free download as powerpoint presentation. Nowadays, cholangioscopy is an established modality in diagnostic and treatment of pancreaticobiliary diseases. Percutaneous antegrade digital cholangioscopy in the. Cholangioscopy and pancreatoscopy are the manifestation of this goal in the bile and pancreatic ducts, respectively. The currently available techniques have some limitations in evaluating indeterminate biliary lesions. Recently, several endoscopists have reported the usefulness of direct peroral video cholangioscopy for the diagnosis and therapy of bile duct lesions. Cholangioscopy is primarily used for the treatment of difficult bile duct stones image 1 and picture 1 and for the evaluation of indeterminate biliary strictures ie, strictures that could not be diagnosed as being benign or malignant with sampling techniques such as brush cytology or biopsy. Hepatolithiasis is the presence of calculi within the intrahepatic bile duct specifically located proximal to the confluence of the left and right hepatic ducts. An overview of the evolution of direct cholangioscopy techniques for diagnosis and therapy rebecca voaklander, md, eileen kim, md, william h.
The role of ercp, eus, and cholangioscopy bilirubin 10 ctpancreas head mass 3. Pdf, epub, full text, audio unceasing customer service track the below url for onestep submission. Cholangioscopy is a noninvasive endoscopic method used for both direct visual diagnostic evaluation and simultaneous therapeutic intervention of the bile ducts. Endoscopic retrograde cholangioscopy ercp is currently the tool of choice. Pancreatoscopy is the direct visual evaluation of the pancreatic ducts. Cholangioscopy and cholangioscopic forceps biopsy in. Endoscopic ultrasound and elastography may add information oncommon bile duct strictures, wall thickening, and. A 21 or 22gauge needle is then advanced into the liver under fluoroscopic guidance by aiming for the 12th thoracic vertebral body. In chromoendoscopy, different stains are topically applied to the surface of the mucosa. As well as needing only a single operator, the spyglass has 4way tip deflection and a singleuse baby endoscope for access and delivery. Limitations of percutaneous transhepatic cholangioscopy for the diagnosis of the intramural extension of bile duct carcinoma. Advances in noninvasive identification of unresectab 3. In selected cases with suspected extrahepatic disease and inconclusive mrc findings. Role of spyglass peroral cholangioscopy in the evaluation.
1463 711 762 228 1618 510 554 1289 580 629 820 979 747 763 566 1443 1410 714 951 180 1395 1028 721 1016 936 840 1329 412 849 664 899 1338 278 749 1052 1004 1086 301 1272 1005 66 579