Cholangioscopy

What is a Cholangioscopy?

Cholangioscopy is a special, miniature, flexible lighted tube that is used to visualize the bile ducts (tubes carrying bile from the liver into the small intestine) and sometimes the main pancreatic duct (tube carrying enzymes and other juices from the pancreas). This instrument is used during an endoscopic retrograde cholangiopancreatography (ERCP), which is the one of the main endoscopic procedures used to investigate and treat disorders of bile ducts and pancreas.

Why is a Cholangioscopy Done?

There are a few reasons for deploying Cholangioscopy during an ERCP:

• To remove larger, more difficult stones in the bile duct or sometimes the main pancreatic duct that could not be extracted safely during standard ERCP. Direct visualization with the cholangioscope permits the doctor to use tools with either laser or electrohydraulic therapy to break up the stone.
• Directly visualize and biopsy growths, tumors and strictures (narrowed segments) in the bile duct.
• Visualize and biopsy growths, tumors in the main pancreatic duct. This is only permissible when the pancreatic duct is enlarged (dilated).

How Does One Prepare for a Cholangioscopy?

Preparation for the Cholangioscopy follows the same steps as one takes for an ERCP. Generally, no eating or drinking is allowed for 6 to 8 hours before the procedure. Smoking and chewing gum are also prohibited during this time. Patients should tell their doctor about all health conditions they have—especially heart and lung problems, diabetes, and allergies— and all medications they are taking. Patients may be asked to temporarily stop taking medications that affect blood clotting or interact with sedatives, which are often given during upper GI endoscopy. Medications and vitamins that may be restricted before and after ERCP include:

• nonsteroidal anti-inflammatory drugs such as aspirin, ibuprofen (Advil), and naproxen (Aleve)
• blood thinners
• blood pressure medications
• diabetes medications
• antidepressants
• dietary supplements

Driving is not permitted for 24 hours after ERCP to allow sedatives time to completely wear off. Before the appointment, patients should make plans for a ride home. Sometimes the patient will be kept in the hospital for observation after the procedure.

How is a Cholangioscopy Performed?

As noted above, Cholangioscopy is typically used during an ERCP. ERCP combines the use of xrays and an endoscope (flexible thin tube with a camera and light source) through which the physician can see the inside of the stomach and duodenum, and inject dyes into the ducts in the biliary tree and pancreas so they can be seen on xrays.

The procedure is performed at a hospital. Patients will first change into a gown and their belongings will be stored in a secure area. Patients may receive a local, liquid anesthetic that is gargled or sprayed on the back of the throat. The anesthetic numbs the throat and calms the gag reflex. An intravenous (IV) needle is placed in a vein in the arm so sedatives can be administered. Sedatives help patients stay relaxed and comfortable. Most patients fall asleep with sedatives during the procedure. While patients are sedated, the doctor and medical staff monitor vital signs. Patients continue to breathe on their own throughout the procedure. The procedure generally takes about 30 minutes to 2 hours.

During the procedure, patients lie on their stomach on an examination table. An endoscope is carefully fed down the esophagus and into the stomach and duodenum. A small camera mounted on the endoscope transmits a video image to a video monitor, allowing close examination of the intestinal lining. Air is pumped through the endoscope to inflate the stomach and duodenum, making them easier to see. The endoscope is advanced down to the duodenum, where the openings of both the common bile and pancreatic ducts are located. The openings are located at the major papilla (or ampulla). Special wires and catheters that slide through the endoscope allow the doctor to gain access into these ducts and permit the physician to inject dyes so the ducts can be seen on xray. Once the physician has gained access in the duct that plans to be directly visualized, then he/she will advance the Cholangioscope into that duct. Further maneuvers will be taken through the miniature scope as deemed appropriate for the purposes of the procedure.

What Happens After a Cholangioscopy is Done?

After the procedure, patients are moved to a recovery room where they wait about an hour for the sedative to wear off. During this time, patients may have abdominal pain, bloating or nausea. They may also have a sore throat, which can stay for a day or two. Patients will likely feel tired and should plan to rest for the remainder of the day. Unless otherwise directed, patients may immediately resume their normal diet and medications.

Some results are available immediately after the procedure. The doctor will often share results with the patient after the sedative has worn off. Biopsy results are usually ready in one to two weeks.