Published online May 16, 2013. doi: 10.4253/wjge.v5.i5.203
Revised: January 5, 2013
Accepted: March 6, 2013
Published online: May 16, 2013
Different diagnostic procedures exist for the detection of bile duct lesions in clinical practice. However, neither retrograde contrast imaging of the bile duct endoscopic retrograde cholangiopancreatogram nor other imaging procedures allow a safe diagnosis of the lesions. Therefore choledochoscopy may be a useful diagnostic procedure in macroscopic assessing lesions of the bile duct. Even if the diagnostic sensitivity and specificity is not sufficient, first studies suggest an enhanced diagnostic accuracy for choledochoscopy. Since the progress of choledochoscopy has started in the 1970 different improvements were achieved. Meanwhile, the examination can be performed by an examiner and samples can be taken. Image and Resolution quality has improved over the past years, also. The SpyGlass system is a technically advanced cholangioscopic device to provide endoscopic diagnosis in case of inconclusive bile duct findings. Further more, two more lumina allow specific biopsy forceps and optical fibers for electrohydraulic or laser lithotripsy. The most frequent useful insert of SpyGlass in clinical practice are in complex gallstones and bile duct lesions of unclear dignity.
Core tip: To date, technical restrictions of endoscopic retrograde cholangiopan-creatogram may explain the insufficient sensitivity of diagnostics when biliary changes are suspected. Therefore choledochoscopy may be a direct diagnostic procedure to help. SpyGlassTM is a technically advanced cholangioscopy system facilitating diagnostics in the bile duct due to its single-operator feature. Different studies reported a clearly enhance diagnostic accuracy for this technique. However, the visualization of bile duct lesions itself is of great value since it offers precise dignity evaluation based on macroscopic criteria.