Post written by Justin Ryan L. Tan, MD, from the Section of Gastroenterology, Chinese General Hospital and Medical Center, Manila, Philippines, and Weigang Gu, MD, from the Department of Gastroenterology, Affiliated Hangzhou First People’s Hospital, Hangzhou, China.

Although cholangioscopy has undergone increasing therapeutic applications, standardized training remains a significant challenge. Our team has focused on simplifying device movements and usage to facilitate easier adoption and skill acquisition.

This article provides a technical overview of the fundamental movements and combination movements for 2 commercially available cholangioscopy systems: SpyGlass DS II (Boston Scientific, Marlborough, Mass, USA) and 9F EyeMax (Micro-Tech Nanjing Co, Ltd, Nanjing, China). This simplified movement guide is important for endoscopists to effectively navigate and manipulate the cholangioscope during digital single-operator cholangioscopy procedures.

To promote a comprehensive understanding of cholangioscope movements and their corresponding effects on orientation within the biliary tract, our team used a custom biliary tract model (Pulse MDM, Holland, Pa, USA). This model allowed direct observation and analysis of cholangioscope behavior in a controlled environment. We have developed a visual reference guide using a clockface analogy to simplify the learning curve for cholangioscope manipulation. This guide can be displayed in endoscopy rooms and workshops to aid in training and skill acquisition.

To optimize cholangioscope maneuverability and functionality, it is essential to retract accessory devices, such as guidewires or biopsy forceps, a few centimeters proximal to the distal tip. This strategic positioning minimizes potential interference with the cholangioscope bending segment and maximizes the range of motion of the distal tip. By reducing the impedance within the working channel, endoscopists can achieve more precise tip deflection and improved overall control during digital cholangioscopy.

Clockwise rotation of the large wheel positions the cholangioscope at the 4- to 5-o’clock position.

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