Post written by Carlos Robles-Medranda, MD, AGAF, FASGE, from the Instituto Ecuatoriano de Enfermedades Digestivas, Guayaquil, Ecuador.

In this review article, we present 4 instances where the 7F cholangioscope emerged as a valuable tool for assessment of challenging biliary ducts, along with a comparative analysis among available cholangioscopes.

In case 1, the 7F cholangioscope facilitated identification of a lesion from the proximal bile duct to both intrahepatic biliary ducts. Moving forward to case 2, assessment of a stricture with a 7F cholangioscope helped us recognize an area of necrosis with friable mucosa. For case 3, the 7F cholangioscope proved instrumental in exhaustive evaluation of the biliary stricture, enabling passage of a 0.025-mm guidewire, which facilitated subsequent stent placement.  

Finally, during case 4, evaluation with the 7F cholangioscope revealed total proximal common bile duct stenosis, cautery ischemia, and biliodigestive anastomosis insufficiency and allowed passage of a 0.025-mm guidewire for subsequent stent placement.

Through this video presentation, we highlight a valuable alternative for cases involving challenging assessments, particularly those complicated by strictures or angulations. In such instances, a small-diameter cholangioscope emerges as a crucial tool for both assessment and therapeutic decision-making.

Based on our experience, other endoscopists may contemplate adoption of this novel small-diameter cholangioscope as an alternative in instances requiring comprehensive, direct visualization of small pancreatobiliary areas and associated stenosis.

This new cholangioscope has proven to be a valuable tool in cases where available cholangioscopes have faced challenges in assessing small biliary tracts. Additional studies are necessary to evaluate its safety and efficacy and establish further recommendations.

Stenosis of the proximal common bile duct was observed during digital single-operator cholangioscopy using a 7F cholangioscope.

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