Overtube-balloon-assisted direct peroral cholangioscopy by using an ultra-slim upper endoscope (with videos)

Background: The "mother-baby" endoscope System currently used for peroral cholangioscopy (POC) has several limitations. Endoscopic direct cholangioscopy when using an ultra-slim upper endoscope with a guidewire to maintain access has been reported, but appropriate accessories are required to increase the Success rate. Herein, we describe a novel method, overtube-balloon-assisted endoscopy, for direct POC. Objective: To evaluate the feasibility and usefulness of direct POC when using an ultra-shin Upper endoscope with an overtube balloon to maintain access. Setting: A single center, Design: Case series. Patients: Twelve patients with biliary disease. Interventions: Direct POC by using an Ultra-slim upper endoscope and diagnostic and/or therapeutic procedures. Main Outcome Measurements: Success rate of this technique, diagnostic or therapeutic feasibility and complications. Results: Overtube-balloon-assisted direct POC was performed successfully in 10 of 12 patients (83.3%). The procedure revealed 4 common bile duct (CBD) stories, 4 benign biliary Strictures, 1 polypoid tumor, and 1 cholangiocarcinoma. Five patients underwent forceps biopsy under direct visualization of the intraductal lesion. Laser lithotripsy was successfully performed in I patient. No procedure-related complication Occurred. Limitations: A small number Of patients and no comparison with conventional cholangioscopy, Conclusions: The overtube balloon appears to be a useful accessory in direct POC When using an Ultra-slim upper endoscope. However, further development of a slim overtube or other accessories is necessary to improve the Success rate of direct POC.