Peroral direct cholangioscopy by freehand intubation using routine straight-view endoscope for diagnosis and therapy of bUiary diseases

Objective To evaluate the feasibility and safety of peroral direct cholangioscopy （PDCS） by freehand intubation using routine straight-view endoscope for diagnosis and therapy of biliary diseases. Methods Patients with bile duct dilation underwent standard ERCP and native papilla was dilated using EST and/or endoscopic papillary large balloon dilation, according to the size of the papilla. Then peroral direct cholangioscopy was performed by freehand intubation using routine straight-view endoscope. General data of patients, procedure of ERCP, diagnosis of PDCS and complications were recorded. Results A total of 5 patients underwent PDCS. Indications included common bile duct stones （ n = 2 ） , intraductal papillary neoplasm of bile buct （ n = 2 ） and benign biliary stricture after removable metal stent placement （ n = 1 ）. The diameter of common bile duct ranges from 1.2 cm to 2. 4 cm. EST or/and EPLBD was required in 3/5 patients to facilitate PDCS. Freehand PDCS intubation of the bile duct was successful in all procedures （ 1 case into distal common bile duct, 4 cases into proximal common bile duct）. Complications were cholangitis managed with intavenous antibiotics （ n = 1 ）. No procedure related death occurred. Conclusion Free- hand PDCS is technically feasible and safe, and may be clinically useful for diagnostic and therapeutic pur- poses in managing select biliary tract diseases. Key words: Biliary tract diseases ;  Cholangiopancreatography, endoscopic retrograde ;  Peroral direct cholangioscopy