Diagnostic cholangioscopy with SpyGlass probe through an endoscopic retrograde cholangiopancreatography cannula.

ing cholangioscopy using the reusable 0.77-mm SpyGlass fiberoptic probe (Boston Scientific, Massachusetts, USA) with two double-lumen endoscopic retrograde cholangiopancreatography (ERCP) cannulae. The TandemXL cannula (Boston Scientific) is a 7-Fr double-lumen catheter with a 5.5-Fr tip (●" Fig. 1a), and the Swing-tip cannula (Olympus, Tokyo, Japan) is a 9-Fr single-lumen catheter with a 4.5-Fr tip with bi-directional swing angle of 105° (●" Fig. 1b) and is used when SpyGlass cholangioscopy is less than ideal (i. e. no sphincterotomy, small-caliber duct) [1,2]. Cholangioscopy using the SpyGlass probe and Tandem catheter (without sphincterotomy) was used to clarify the nature of the round filling defects in the left intrahepatic ducts in a patient with jaundice and a history of right hepatectomy for metastatic colon cancer. In contrast to the suspected biliary stones, a polypoid tumor was found, consistent with recurrent disease (●" Fig. 2a,b). In the second patient, combined SpyGlass probe and Swing-tip cannula (irrigation via Touhy Borst attachment) was used to determine whether complete clearance of stonefragmentshadbeenachieved following mechanical lithotripsy of a large common bile duct stone (●" Fig. 2c,d). The major advantage of this technique is the ability to cannulate non-dilated or small biliary (or pancreatic) ducts without the need for sphincterotomy,whichwould be useful for patients who are at risk for sphincterotomy complications due to bleeding diathesis or who have unfavorable anatomy (e.g. small ampulla, Billroth II gastrectomy). It would also be useful for examining lesions located in the small intrahepatic ducts, which would be difficult for the 3.3-mm caliber SpyScope to reach [1,2]. Furthermore, this technique is extremelycost-effectivefor selecteddiagnostic cases. The cost of the TandemXL catheter is one-tenth (US$ 67) and the Swing-tip cannula one-fifth (US$ 130) of the SpyScope assembly (US$ 670). With the lifespan of up to 20 uses [2], the estimated cost of the SpyProbe per use is ~US$ 250.