Intraductal Cholangio-Pancreatoscopy for Large Bile Duct and Pancreatic Duct Stones
Intraductal cholangio-pancreatoscopy is an advanced endoscopic procedure that allows direct visualization and treatment of difficult-to-remove stones in the bile duct and pancreatic duct. It is particularly helpful when standard procedures like ERCP are not sufficient to manage large, impacted, or complex stones.
What is it?
This technique uses a miniature endoscope (called a cholangioscope or pancreatoscope) inserted through the working channel of a standard endoscope. It provides real-time, high-resolution images of the inside of the bile and pancreatic ducts, enabling:
- Accurate diagnosis
- Targeted stone removal
- Laser or electrohydraulic lithotripsy (breaking large stones into smaller pieces)
When is cholangio-pancreatoscopy recommended?
This procedure is ideal for patients with:
- Large or impacted bile duct stones
- Stones that failed to be removed by standard ERCP
- Stones in the intrahepatic ducts or difficult pancreatic duct stones
- Anatomical challenges (e.g., surgically altered GI tracts)
- Suspicion of bile duct tumors requiring direct visualization or biopsy
How is the procedure performed?
- The procedure begins with an ERCP to access the bile or pancreatic duct.
- A thin, flexible cholangioscope is introduced into the duct.
- The physician directly visualizes the stone.
- If the stone is large or hard, laser lithotripsy or electrohydraulic lithotripsy (EHL) is used to break it.
- The stone fragments are then removed using baskets or balloons.
Advantages of intraductal cholangio-pancreatoscopy:
- Direct visualization of stones and duct lining
- Enables removal of difficult and large stones
- Reduces the need for surgical intervention
- Allows targeted biopsy if abnormal tissue is seen
- Improves diagnostic accuracy for biliary and pancreatic duct diseases
Is it safe?
Yes, the procedure is considered safe and effective, especially in experienced hands. Risks are similar to those of ERCP and may include:
- Pancreatitis
- Infection
- Bleeding
- Duct injury (rare)
Aftercare:
- Most patients recover quickly and may go home the same or next day.
- Your doctor will provide guidance on diet, medications, and any follow-up procedures if needed.
- Repeat procedures may be scheduled for complex stone cases.
Intraductal cholangio-pancreatoscopy is a cutting-edge solution for complex biliary and pancreatic duct stones, ensuring precision, safety, and improved outcomes.
