Post written by Shuji Mitsuhashi, MBBS, Chinmay Guralwar, MBBS, and Vinay Chandrasekhara, MD, from the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.

This video demonstrates the use of a novel single-use peroral cholangiopancreatoscopy system (Dragonfly Endoscopy Inc, Englewood, Colo, USA) for diagnostic and therapeutic pancreatobiliary interventions during ERCP. The cases highlight direct visualization of indeterminate biliary strictures, intraductal tumor evaluation with targeted tissue acquisition, and management of difficult biliary and pancreatic stone disease using electrohydraulic lithotripsy. 

The video also notes several technical features of the platform, including continuous 360-degree scope rotation, ±210-degree tip deflection with lateral flexion capability, increased irrigation capacity, and a larger 1.7-mm working channel. The system is compatible with large-volume biopsy forceps with a 6-mm jaw span opening as well as a 4.5F electrohydraulic lithotripsy probe. Practical techniques for scope manipulation, stable ductal positioning, and optimization of intraductal visualization also are shown throughout the cases.

Cholangiopancreatoscopy continues to evolve rapidly, with increasing applications in diagnostic and therapeutic endoscopy. However, currently available systems may still present limitations related to maneuverability, irrigation, and accessory compatibility. We felt it was important to showcase this novel platform because it displays technical modifications that may improve usability, procedural efficiency, and therapeutic capability during routine clinical practice.

This video addresses important technical considerations for successful cholangiopancreatoscopy, including stable ductal navigation, controlled scope manipulation, and optimization of intraductal visualization. In addition, endoscopists can appreciate how enhanced maneuverability and expanded accessory compatibility may facilitate tissue acquisition and lithotripsy during management of complex pancreatobiliary disease.

Although larger comparative studies are needed, our early experience suggests this novel single-use cholangiopancreatoscopy platform represents a promising advancement in direct intraductal endoscopy for tumor detection and stone management.

Novel peroral cholangiopancreatoscopy system components and procedural set-up. A, Close-up of the handle demonstrating the yellow attachment lock, gray rotational dial for 360° scope rotation, and blue dial for tip deflection. B, In-room procedural set-up showing scope handling and coordination.

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