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Clinical Application and Progress of Cholangiopancreatoscopy in Pancreatobiliary Diseases

  • Bin Xiao1,2,
  • Guo-Sheng Chen1,2,
  • Hao Yuan1,2,
  • Li Zhao1,2,
  • Shao-Qing Fan1,2,
  • Kui-Rong Jiang1,2 and
  • Yi Miao1,2,* 
 Author information  Cite
Cancer Screening and Prevention   2022;1(1):72-76

doi: 10.14218/CSP.2022.00010

Abstract

Cholangiopancreatoscopy with the SpyGlass system is a direct and minimally invasive examination method in which the lesions in the pancreatic bile tract can be observed directly by inserting an ultra-fine endoscope through the biopsy channel of a duodenoscope. Compared with endoscopic retrograde cholangiopancreatography (ERCP), enhanced computed tomography, magnetic resonance imaging, and endoscopic ultrasonography, cholangiopancreatoscopy with the SpyGlass system has unique advantages for observing and identifying lesions originating in the pancreatic bile duct. In recent years, with the upgrading of endoscopic equipment and the improvement of operating technology, the application of cholangiopancreatoscopy is becoming more and more widespread. This article reviews the use of cholangiopancreatoscopy with the SpyGlass system for the diagnosis and treatment of pancreaticobiliary disease.

Keywords

Clinical application, Cholangiopancreatoscopy, Pancreatobiliary diseases

Introduction

Traditional imaging techniques such as endoscopic retrograde cholangiopancreatography (ERCP), magnetic resonance imaging, and enhanced computed tomography are valuable tools for the evaluation and treatment of pancreatic and biliary diseases; specifically, ERCP is currently the first choice for the diagnosis and evaluation of pancreatic biliary diseases.1,2 However, its limitation lies in that when diagnosing pancreatic and bile duct diseases, endoscopists can only observe the pancreatic and bile duct structure indirectly through fluoroscopy, and the imaging quality is also unsatisfactory.3 In addition, the sensitivity and accuracy of brush cytology and biopsy are also limited due to the fact that the lesions cannot be observed under direct vision. Currently, with the introduction and upgrade of the SpyGlass system, cholangiopancreatoscopy has been proven to be a reliable and effective method for assessing pancreaticobiliary disease.4 In particular, the introduction of the second-generation SpyGlass system has provided a higher imaging quality and a wider field of view.5

History of cholangiopancreatoscopy

A peroral pancreatoscope was first reported and applied clinically by Katagi et al. in 1974.6 It was mainly applied for diagnosing lesions in the pancreatic and bile duct due to its advantage of directly observing the condition of the pancreatobiliary duct. However, because of its complex equipment, high operation difficulty, complications, small operation area, and poor imaging quality, it has not been promoted in clinical diagnosis and treatment.7 In the 1980s, with the development of digital imaging technology and endoscopic manipulation, cholangiopancreatoscopy was able to detect subtle lesions in the pancreatic or bile ducts. In addition, the improvement of auxiliary equipment also enabled the operation of endoscopic lesion biopsy or treatment. In 2007, Boston Scientific (Natick, MA, USA) released the first-generation SpyGlass system, which is a reusable single-operator fiberoptic scope with a mother-baby system including a channel for accessory instruments and irrigation capabilities. With an external diameter of 3.3 cm and a length of 230 cm, the SpyGlass system can be used in combination with a duodenoscope, overcoming several weaknesses of previous pancreaticoscopy, including vulnerability, low image quality, and operation difficulty.8–10 A study consisting of 300 patients performed by 15 medical centers demonstrated that the SpyGlass system had an improved diagnostic accuracy in patients with pancreatic and biliary disease.4 Hence, in 2009, the U.S. Food and Drug Administration approved the SpyGlass system for the diagnosis and treatment of pancreatic biliary disease.11 The second-generation SpyGlass system was introduced in 2015, and compared with the first-generation SpyGlass system, the new SpyGlass system has a further improved image resolution and operational vision field.12 Moreover, a recent study was designed to compare the effects of fiberoptic and digital cholangiopancreatoscopy. The results showed a considerable increase in utilization rates of cholangiopancreatoscopy in pancreatic biliary disease, indicating that the technology improvement in the SpyGlass system made the use of cholangiopancreatoscopy more widespread.13

Clinical application

In the diagnosis and treatment of pancreatic and biliary diseases, the use of endoscopy can shorten the examination distance through the natural cavity. Additionally, the application of endoscopy has been shown to improve the diagnosis rate and treatment effect of diseases.14 The SpyGlass system has advantages over ERCP and has been increasingly used in cholangiopancreatography in recent years.15–17 The following sections describe the application of cholangiopancreatoscopy in the treatment of pancreatic biliary system diseases.

Biliary tract diseases

Recent studies have demonstrated that the SpyGlass system is beneficial for patients with difficult or undiagnosed bile duct stones.18–20 When a stone is embedded in the cystic duct or attached to the duct wall, it is difficult to show the stone position clearly with conventional cholangiography. The SpyGlass system, however, can detect stones under direct vision and remove them by placing a guide wire.14 Furthermore, for patients with recurrent cholangitis, significant dilation of the bile duct, and missed biliary stones, the SpyGlass system can also be used to directly explore the bile duct to find lesions.21 A single-center study consisting of 39 patients with biliary stones indicated that the use of the SpyGlass system successfully removed biliary stones in 82.1% of patients.22 The advantage of the SpyGlass system is that it clearly shows the extrahepatic and proximal intrahepatic bile ducts.

In addition to biliary stones, the SpyGlass system also has advantages in the diagnosis of biliary strictures, especially those with undiagnosed benign or malignant lesions.23,24 Due to the limited sensitivity and positive rate of ERCP with brush cytology and biopsy, studies have shown that the postoperative pathology of some patients with biliary stenosis was not a malignant tumor.25 However, surgery for a biliary malignant tumor usually involves great trauma, many complications, and a long recovery time. Therefore, the accurate diagnosis of benign or malignant biliary stenosis is of great importance for the clinical treatment of patients.

De Oliveira et al. recruited 283 patients in 6 studies and concluded that the use of the SpyGlass system for the diagnosis of malignant biliary stenosis had a sensitivity, specificity, and accuracy of 94%, 95%, and 94%, respectively.26 Moreover, a prospective randomized multicenter trial indicated that the SpyGlass choledochoscopy system was more sensitive than ERCP for the histological diagnosis of unclear bile duct stenosis.27 The application of the SpyGlass system allowed direct examination of biliary stenosis and a more accurate biopsy under direct vision; these benefits also have been reported in several case reports of bile duct cancer treatment.28–30 In addition to the previously mentioned direct vision and tissue biopsy for bile duct stenosis, the SpyGlass system could resolve bile duct lesions via radiofrequency ablation as well.31 As described in a bile duct stenosis case report, the patient underwent SpyGlass-guided radiofrequency ablation for recurrent bile duct carcinoma, and radiofrequency ablation was performed in multiple bile duct stenosis segments under cholangioscopy with direct vision.32 The patient recovered well after the operation. Another patient had a resectable intraductal papilloma in the bile duct and opted for endoscopic treatment. After the physicians performed the biopsy for the lesion, the patient underwent a lesion radiofrequency ablation operation and was discharged normally.33

Choledochoscopy with the SpyGlass system also has demonstrated advantages for diagnosing hemobilia.34 Traditional ERCP and magnetic resonance cholangiopancreatography methods can identify hemobilia; however, they cannot unveil the underlying pathogenesis of biliary bleeding. Choledochoscopy can help to detect the exact source of bleeding, and biopsy under direct vision via the SpyGlass system can obtain a pathological diagnosis. A previous case report describes a patient with biliary hemorrhage, and the pathogenesis could not be determined by magnetic resonance cholangiopancreatography. Therefore, cholangioscopy with the SpyGlass system was performed. It was found that the cause of the patient’s bleeding was due to biliary vascular dysplasia, which is a rare type of hemobilia.35

Pancreatic neoplasms

With advances in endoscopic manipulation, the use of the SpyGlass system also has been reported in pancreatic diseases, especially in pancreatic cancer, intraductal papillary tumors, and pancreatic duct stenosis.14,36 Previous studies have demonstrated that the sensitivity and specificity of conventional examination methods, including computed tomography, ERCP, and endoscopic ultrasonography, have been significantly improved in the diagnosis of pancreatic tumors, while the sensitivity for tumors with a diameter of less than 2 cm is still unsatisfactory.37,38 Therefore, it is crucial to use the SpyGlass system, which takes a direct view into the pancreatic duct for these patients. A pancreatic intraductal papillary mucinous neoplasm (IPMN) can be divided into the main pancreatic duct (MD-IPMN), branching pancreatic duct (BD-IPMN), and mixed type according to the range of lesions involved, which mainly grow along the pancreatic duct in a multifocal or skip growth way.39 Fritz et al. retrospectively analyzed the data of 287 surgically resected IPMN patients, among which 51 patients (17.8%) had multifocal lesions.40 In addition, He et al. found that the postoperative recurrence rate of IPMN patients was about 17%,41 and the recurrence risk was time-cumulative, with recurrence rates of 4%, 25%, and 62% at 1, 5, and 10 years after surgery, respectively. For IPMNs, the pancreatic duct lesions can be observed and biopsied under direct vision by the SpyGlass system. Therefore, the diagnostic value of the SpyGlass system for IPMNs is better than that of traditional imaging examination. Hara et al. have reported that the accuracy rates of MD-IPMN and BD-IPMN diagnosis by oral pancreatoscopy were 88% and 67%, respectively, and the pancreatic duct lesions observed by pancreatoscopy were classified into the following five categories: granular mucosa, seed-like protrusion without covered vessels, seed-like protrusion with covered vessels, villous protrusion, and florid papillomatosis, among which the latter three categories were more malignant.37 The SpyGlass system can also be used to assess the extent of IPMN involvement before surgery. For example, Tyberg et al. analyzed the data of 13 patients who underwent preoperative pancreaticoscopy, among which 8 patients changed their surgical plan due to pancreaticoscopy, 4 patients expanded the surgical scope, and 4 patients narrowed the surgical scope, but 2 of the 4 patients obtained positive surgical margins.42 According to existing reports, preoperative oral pancreaticoscopy with the SpyGlass system for IPMN detection could obtain good diagnostic results; however, the guiding effect for the surgical resection scope was inadequate. Currently, there are few studies describing the application of intraoperative pancreatoscopy for IPMN patients. Kaneko et al. have reported cases of intraoperative pancreatoscopy for IPMN resection and found that the sensitivity, specificity, and accuracy of intraoperative pancreatoscopy were all 100%, superior to ERCP and endoscopic ultrasonography.43 Moreover, a recent study by Wei et al. recruited 10 patients with MD-IPMN. All of the patients underwent intraoperative pancreatoscopy with the SpyGlass system. The examination results revealed that four patients had positive surgical margins, which required the surgeon to expand the resection scope. The application of intraoperative pancreatoscopy is still limited; however, a pancreaticoscope can be directly inserted into the pancreatic duct during the operation and help surgeons to determine the margin of pancreatic duct lesions under direct vision to achieve the surgical resection. Hence, compared with other imaging examination methods, pancreaticoscopy with the SpyGlass system still has unique advantages.

Complications

Although there have been limited reports of complications related to cholangiopancreatoscopy with the SpyGlass system, endoscopic treatment is generally considered to be a safe procedure with few complications.9 Postoperative complications of pancreaticoscopy with the SpyGlass system include pancreatitis, celialgia, cholangitis, biliary tract infection, and duodenal perforation. In a clinical study consisting of 36 biliary stenosis patients who underwent pancreaticoscopy with the SpyGlass system, only one patient developed mild pancreatitis and two patients developed cholangitis during a follow-up period of at least one month, both of whom recovered with medication.44 Duodenal perforation is also a rare complication, and conservative treatment is recommended.

Conclusions

Cholangiopancreatoscopy with the SpyGlass system provides better image resolution and enables surgeons to observe lesions under direct vision as well as to obtain biopsied tissue for pathological examination. Previous studies have demonstrated the SpyGlass system to be cost-effective, and cholangiopancreatoscopy is becoming an effective tool for the diagnosis and treatment of pancreatic biliary diseases. With the further development of digital technology, the introduction of the third-generation SpyGlass system will provide cholangiopancreatoscopy with a higher resolution and a wider vision field. In conclusion, cholangiopancreatoscopy with the SpyGlass system is an exciting technology and treatment method that will play a more important role in pancreatic biliary diseases in the future.

Abbreviations

CT: 

computed tomography

ERCP: 

endoscopic retrograde cholangiopancreatography

EUS: 

endoscopic ultrasonography

MRI: 

magnetic resonance imaging

IPMN: 

pancreatic intraductal papillary mucinous neoplasm

Declarations

Acknowledgement

None.

Funding

This study was supported by the National Natural Science Foundation of China (No. 82072706 and No. 82173206) and the Clinical Ability Improvement Project of Jiangsu Provincial People’s Hospital.

Conflict of interest

One of the authors, Prof. Yi Miao, has been an editorial board member of Cancer Screening and Prevention since March 2022. The authors declare no other competing interests.

Authors’ contributions

YM and KRJ designed and conceived the project. HY, GSC, LZ, and SQF collected the related articles. BX drafted the manuscript.

References

  1. Azab M, Bharadwaj S, Jayaraj M, Hong AS, Solaimani P, Mubder M, et al. Safety of endoscopic retrograde cholangiopancreatography (ERCP) in pregnancy: A systematic review and meta-analysis. Saudi J Gastroenterol 2019;25(6):341-354 View Article PubMed/NCBI
  2. Nalankilli K, Kannuthurai S, Moss A. A modern approach to ERCP: maintaining efficacy while optimising safety. Dig Endosc 2016;28(Suppl 1):70-76 View Article PubMed/NCBI
  3. Chen YK, Pleskow DK. SpyGlass single-operator peroral cholangiopancreatoscopy system for the diagnosis and therapy of bile-duct disorders: a clinical feasibility study (with video). Gastrointest Endosc 2007;65(6):832-841 View Article PubMed/NCBI
  4. Chen YK, Parsi MA, Binmoeller KF, Hawes RH, Pleskow D, Slivka A, et al. Cholangioscopy (PO) using a disposable steerable single operator catheter for biliary stone therapy and assessment of indeterminate strictures - a multi-center experience using Spyglass. Gastrointest Endosc 2008;67(5):PAB103 View Article
  5. Kantamaneni V, Singh S, Kulkarni A, Dhawan M, Farah K, Thakkar S. Diagnostic and therapeutic utility of second generation SpyGlass DS in pancreatobiliary disorders: 862. The American Journal of Gastroenterology 2017;112:S486-S488
  6. Takagi K, Takegoshi T. Endoscopic diagnosis of pancreatic cancer (in Japanese). Stom Intest 1974;9:1533-1541
  7. Navaneethan U, Njei B, Lourdusamy V, Konjeti R, Vargo JJ, Parsi MA. Comparative effectiveness of biliary brush cytology and intraductal biopsy for detection of malignant biliary strictures: a systematic review and meta-analysis. Gastrointest Endosc 2015;81(1):168-176 View Article PubMed/NCBI
  8. Parsi MA. Peroral cholangioscopy in the new millennium. World J Gastroenterol 2011;17(1):1-6 View Article PubMed/NCBI
  9. Williamson JB, Draganov PV. The usefulness of SpyGlass™ choledochoscopy in the diagnosis and treatment of biliary disorders. Curr Gastroenterol Rep 2012;14(6):534-541 View Article PubMed/NCBI
  10. Raijman I, Fishman DS, Tarnasky PR, Patel S. Spyglass: experience with a new mini-endoscope in bilio-pancreatic disease. Gastrointest Endosc 2008;67(5):PAB229 View Article
  11. Woo YS, Lee JK, Oh SH, Kim MJ, Jung JG, Lee KH, et al. Role of SpyGlass peroral cholangioscopy in the evaluation of indeterminate biliary lesions. Dig Dis Sci 2014;59(10):2565-2570 View Article PubMed/NCBI
  12. Mizrahi M, Wang Y, Jonah C, Chuttani R, Sawhney M; Berzin TM, et al. Light at the end of the tunnel: comparative effectiveness of second-generation digital SpyGlass with first-generation SpyGlass (R) cholangioscopy. Am J Gastroenterol 2015;110:S25
  13. Dimas ID, Vardas E, Papastergiou V, Fragaki M, Velegraki M, Mpitouli A, et al. Comparison of digital versus fiberoptic cholangioscopy in patients requiring evaluation of bile duct disease or treatment of biliary stones. Ann Gastroenterol 2019;32(2):199-204 View Article PubMed/NCBI
  14. Yodice M, Choma J, Tadros M. The Expansion of Cholangioscopy: Established and investigational uses of SpyGlass in biliary and pancreatic disorders. Diagnostics (Basel) 2020;10(3):132 View Article PubMed/NCBI
  15. Moon JH, Terheggen G, Choi HJ, Neuhaus H. Peroral cholangioscopy: diagnostic and therapeutic applications. Gastroenterology 2013;144(2):276-282 View Article PubMed/NCBI
  16. Pereira P, Vilas-Boas F, Peixoto A, Andrade P, Lopes J, Macedo G. How SpyGlass™ may impact endoscopic retrograde cholangiopancreatography practice and patient management. GE Port J Gastroenterol 2018;25(3):132-137 View Article PubMed/NCBI
  17. Ang TL, Kwek ABE. Safety and efficacy of SpyGlass cholangiopancreatoscopy in routine clinical practice in a regional Singapore hospital. Singapore Med J 2019;60(10):538-544 View Article PubMed/NCBI
  18. Kalaitzakis E, Webster GJ, Oppong KW, Kallis Y, Vlavianos P, Huggett M, et al. Diagnostic and therapeutic utility of single-operator peroral cholangioscopy for indeterminate biliary lesions and bile duct stones. Eur J Gastroenterol Hepatol 2012;24(6):656-664 View Article PubMed/NCBI
  19. Li G, Pang Q, Zhai H, Zhang X, Dong Y, Li J, et al. SpyGlass-guided laser lithotripsy versus laparoscopic common bile duct exploration for large common bile duct stones: a non-inferiority trial. Surg Endosc 2021;35(7):3723-3731 View Article PubMed/NCBI
  20. Raijman I, Fishman DS, Tarnasky PR, Patel S. Spyglass: experience with a new choledochoscope in the management of difficult bile duct stones. Gastrointest Endosc 2008;67(5):PAB232 View Article
  21. Averbukh LD, Miller D, Birk JW, Tadros M. The utility of single operator cholangioscope (Spyglass) to diagnose and treat radiographically negative biliary stones: A case series and review. J Dig Dis 2019;20(5):262-266 View Article PubMed/NCBI
  22. Laleman W, Verraes K, Van Steenbergen W, Cassiman D, Nevens F, Van der Merwe S, et al. Usefulness of the single-operator cholangioscopy system SpyGlass in biliary disease: a single-center prospective cohort study and aggregated review. Surg Endosc 2017;31(5):2223-2232 View Article PubMed/NCBI
  23. Woo YS, Lee JK, Noh DH, Park JK, Lee KH, Lee KT. SpyGlass cholangioscopy-assisted guidewire placement for post-LDLT biliary strictures: a case series. Surg Endosc 2016;30(9):3897-3903 View Article PubMed/NCBI
  24. Bhat YM, Kochman ML. Novel management of complex hilar biliary strictures with the Spyglass Direct Visualization System (with video). Gastrointest Endosc 2009;69(6):1182-1184 View Article PubMed/NCBI
  25. Wakai T, Shirai Y, Sakata J, Maruyama T, Ohashi T, Korira PV, et al. Clinicopathological features of benign biliary strictures masquerading as biliary malignancy. Am Surg 2012;78(12):1388-1391 PubMed/NCBI
  26. de Oliveira PVAG, de Moura DTH, Ribeiro IB, Bazarbashi AN, Franzini TAP, Dos Santos MEL, et al. Efficacy of digital single-operator cholangioscopy in the visual interpretation of indeterminate biliary strictures: a systematic review and meta-analysis. Surg Endosc 2020;34(8):3321-3329 View Article PubMed/NCBI
  27. Gerges C, Beyna T, Tang RSY, Bahin F, Lau JYW, van Geenen E, et al. Digital single-operator peroral cholangioscopy-guided biopsy sampling versus ERCP-guided brushing for indeterminate biliary strictures: a prospective, randomized, multicenter trial (with video). Gastrointest Endosc 2020;91(5):1105-1113 View Article PubMed/NCBI
  28. Takeda Y, Onoyama T, Sakamoto Y, Kawahara S, Hamamoto W, Koda H, et al. A Case of right hepatic artery syndrome diagnosed by using SpyGlassDS™ system. Yonago Acta Med 2020;63(4):372-375 View Article PubMed/NCBI
  29. Leblanc S, Vienne A, Duchmann JC, Gaudric M, Boyer J, Mangialavori L, et al. Combined cholangioscopy (Spyglass®) and probe-based confocal laser endomicroscopy (pCLE) in undetermined biliary stenosis: preliminary results. Gastroenterology 2011;1:S756 View Article
  30. Manta R, Frazzoni M, Conigliaro R, Maccio L, Melotti G, Dabizzi E, et al. SpyGlass single-operator peroral cholangioscopy in the evaluation of indeterminate biliary lesions: a single-center, prospective, cohort study. Surg Endosc 2013;27(5):1569-1572 View Article PubMed/NCBI
  31. Guo X, Wang HG, Wang MT, Guo QM, Li MY, Tao LY, et al. Application of SpyGlass DS choledochoscopy combined with radiofrequency ablation in diagnosis and treatment of extrahepatic cholangiocarcinoma (in Chinese). China Journal of Endoscopy 2019;25(8):75-79 View Article
  32. Gunasingam N, Craig PI. Cholangioscopy-directed radiofrequency ablation of complex biliary cholangiocarcinoma. VideoGIE 2019;4(5):211-213 View Article PubMed/NCBI
  33. Natov NS, Horton LC, Hegde SR. Successful endoscopic treatment of an intraductal papillary neoplasm of the bile duct. World J Gastrointest Endosc 2017;9(5):238-242 View Article PubMed/NCBI
  34. Karagyozov P, Boeva I, Tishkov I. Role of digital single-operator cholangioscopy in the diagnosis and treatment of biliary disorders. World J Gastrointest Endosc 2019;11(1):31-40 View Article PubMed/NCBI
  35. Zhang L, Craig PI. A case of hemobilia secondary to cancer of the gallbladder confirmed by cholangioscopy and treated with a fully covered self-expanding metal stent. VideoGIE 2018;3(12):381-383 View Article PubMed/NCBI
  36. Xu C, Li P, Zhang S, Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University. Application of SpyGlass single-operator cholangioscopy system in biliopancreatic disease. Journal of Capital Medical University 2014;35(2):261-264 View Article
  37. Hara T, Yamaguchi T, Ishihara T, Tsuyuguchi T, Kondo F, Kato K, et al. Diagnosis and patient management of intraductal papillary-mucinous tumor of the pancreas by using peroral pancreatoscopy and intraductal ultrasonography. Gastroenterology 2002;122(1):34-43 View Article PubMed/NCBI
  38. Furukawa T, Tsukamoto Y, Naitoh Y, Hirooka Y, Hayakawa T. Differential diagnosis between benign and malignant localized stenosis of the main pancreatic duct by intraductal ultrasound of the pancreas. Am J Gastroenterol 1994;89(11):2038-2041 PubMed/NCBI
  39. Tanaka M, Fernández-del Castillo C, Adsay V, Chari S, Falconi M, Jang JY, et al. International Association of Pancreatology. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology 2012;12(3):183-197 View Article PubMed/NCBI
  40. Fritz S, Schirren M, Klauss M, Bergmann F, Hackert T, Hartwig W, et al. Clinicopathologic characteristics of patients with resected multifocal intraductal papillary mucinous neoplasm of the pancreas. Surgery 2012;152(3 Suppl 1):S74-S80 View Article PubMed/NCBI
  41. He J, Cameron JL, Ahuja N, Makary MA, Hirose K, Choti MA, et al. Is it necessary to follow patients after resection of a benign pancreatic intraductal papillary mucinous neoplasm?. J Am Coll Surg 2013;216(4):657-65 View Article PubMed/NCBI
  42. Tyberg A, Raijman I, Siddiqui A, Arnelo U, Adler DG, Xu MM, et al. Digital pancreaticocholangioscopy for mapping of pancreaticobiliary neoplasia: can we alter the surgical resection margin?. J Clin Gastroenterol 2019;53(1):71-75 View Article PubMed/NCBI
  43. Kaneko T, Nakao A, Nomoto S, Furukawa T, Hirooka Y, Nakashima N, et al. Intraoperative pancreatoscopy with the ultrathin pancreatoscope for mucin-producing tumors of the pancreas. Arch Surg 1998;133(3):263-267 View Article PubMed/NCBI
  44. Ramchandani M, Reddy DN, Gupta R, Lakhtakia S, Tandan M, Darisetty S, et al. Role of single-operator peroral cholangioscopy in the diagnosis of indeterminate biliary lesions: a single-center, prospective study. Gastrointest Endosc 2011;74(3):511-519 View Article PubMed/NCBI
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Clinical Application and Progress of Cholangiopancreatoscopy in Pancreatobiliary Diseases

Bin Xiao, Guo-Sheng Chen, Hao Yuan, Li Zhao, Shao-Qing Fan, Kui-Rong Jiang, Yi Miao
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