Peroral Cholangiopancreatoscopy with the SpyGlass® System: What do we Know 10 Years Later

Smaller endoscopes and catheters have been developed that permit direct visualization of the bile and pancreatic ducts (cholangioscopy and pancreatoscopy, respectively). These endoscopes and catheters are passed through the working channel of a standard therapeutic duodenoscope during endoscopic retrograde cholangiopancreatography (ERCP). The SpyGlass Direct Visualization System (Boston Scientific Corp, Natick, MA, USA) is currently the most widely used and studied device. Cholangioscopy with intraductal lithotripsy has become an established modality in the treatment of difficult biliary lithiasis. When used in the evaluation of indeterminate biliary strictures by experienced endoscopists in recognizing intraductal pathology, it increases the diagnostic yield of tissue sampling. Pancreatoscopy is complementary to other imaging modalities in the evaluation of intraductal papillary mucinous neoplasms of the pancreas and is emerging as a sole or adjunctive therapy to extracorporeal shock wave lithotripsy for the treatment of main pancreatic duct stones. It remains investigational in the diagnosis of pancreatic adenocarcinoma. Complications specific to the performance of cholangiopancreatoscopy include cholangitis, which is related to intraductal fluid irrigation.Abbreviations: EHL: Electrohydraulic lithotripsy; ERCP: Endoscopic retrograde cholangiopancreatography; ESWL: Extracorporeal lithotripsy by shock waves; ET: Endoscopic therapy; EUS: Endoscopic ultrasound; IPMN: intraductal papillary mucinous neoplasm; LL: Laser lithotripsy; MDCT: Multi-detector computed conventional tomography; MPD: Main pancreatic duct; MRCP: Magnetic resonance cholangiopancreatography; MRI: Magnetic resonance imaging; POCPS: Peroral cholangiopancreatoscopy; PSC: Primary sclerosing cholangitis