Yun Nah Lee, MD, and colleagues from the Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, in Bucheon and Seoul, Korea discuss this New Methods article “A newly modified access balloon catheter for direct peroral cholangioscopy by using an ultraslim upper endoscope (with videos).”

Direct peroral cholangioscopy (POC) using an ultraslim upper endoscope has been increasingly applied as an alternative to the conventional mother-baby endoscope system because of its superior imaging quality. However, accessibility to the bile duct during direct POC remains a limitation despite the use of various accessories, such as an access balloon catheter. The 5F balloon catheter has been modified to make direct POC more convenient for accessing the bile duct. In our study, we performed intraductal balloon-guided direct POC using the newly modified 5F balloon catheter in patients with a biliary obstruction, resulting in a high technical success rate and acceptable mean intubation time.

Direct POC using an ultraslim upper endoscope has become an important single operator cholangioscopy modality. Many endoscopists anticipate using direct POC for diagnosis and treatment of various biliary diseases; however, it has remained difficult using direct POC in practice until a new 5F access balloon catheter was developed as a dedicated accessory. This catheter has produced high technical success rates and shorter intubation times compared with those of previous reports. Therefore, we expect that this modified 5F balloon catheter will facilitate use of intraductal balloon-guided direct POC for more patients with diverse biliary diseases.

The advent of the modified 5F balloon catheter will allow examinations inside the biliary tree and diagnoses and treatments of various biliary diseases for more patients. However, unresolved problems remain, such as instability of the endoscope position after removing the balloon catheter, inconvenience of the procedure, and the possibility of air embolism. Therefore, for expanding a use of direct POC, continuous efforts are still required.

Find the abstract for this article here.

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