What is Cholangioscopy?

Cholangioscopy is an advanced endoscopic procedure that allows direct visualization of the bile ducts using a tiny camera passed through an endoscope. It plays a crucial role in diagnosing and treating various biliary tract conditions, especially when conventional imaging techniques (like MRCP or ERCP) are inconclusive. The bile duct is a small tube-like structure that carries bile from the liver and gallbladder to the small intestine (duodenum). Bile is a fluid that helps digest fats in the food we eat.

Types of Cholangioscopy

Peroral Cholangioscopy (POC): This is the most common type of cholangioscopy in which the bile ducts are accessed through the mouth using an endoscope.
Percutaneous Cholangioscopy: This type of cholangioscopy involves a small incision through the skin to access the bile ducts.
Intraductal Cholangioscopy: In this type of cholangioscopy, a miniature scope is introduced into the bile ducts through an already placed catheter or endoscope.

Indications for Cholangioscopy

Cholangioscopy is typically used for:

Evaluation of indeterminate bile duct strictures (e.g., cancer vs. scar tissue)
Removal of difficult bile duct stones
Guided biopsy of suspicious lesions
Tumor mapping before surgery
Management of bile duct leaks or infections

Procedure for Cholangioscopy

Cholangioscopy is usually performed during an endoscopic retrograde cholangiopancreatography (ERCP) procedure. Fasting is required for 6–8 hours before the procedure. The procedure typically begins with the patient under sedation or anesthesia. A flexible endoscope is passed through the mouth, down the esophagus, through the stomach, and into the duodenum (the first part of the small intestine). Once the endoscope reaches the opening of the bile duct (the ampulla of Vater), a smaller camera-equipped device called a cholangioscope is inserted into the bile duct through a working channel of the endoscope. This allows the physician to directly inspect the inside of the bile ducts, identify any abnormalities such as strictures, tumors, or stones, and perform targeted interventions. If necessary, instruments can be passed through the cholangioscope to take biopsies or remove stones using techniques like laser or electrohydraulic lithotripsy. After the evaluation and any treatments are completed, the instruments are withdrawn, and the patient is moved to the recovery area.

Post-Procedure Care and Recovery

After a cholangioscopy procedure, the patient is monitored in a recovery area until the effects of sedation wear off, which usually takes a few hours. During this time, vital signs are observed, and the patient is assessed for any immediate complications such as abdominal pain, nausea, or signs of infection. Some may experience a sore throat, mild bloating, or discomfort, which typically resolves quickly. Most patients can go home the same day, although they are advised to rest and avoid driving or strenuous activity for 24 hours. The doctor will provide follow-up instructions and discuss preliminary findings, while biopsy results or lab tests, if taken, are usually available within a few days.