Cholangioscopy

What is Cholangioscopy?

Cholangioscopy is a noninvasive endoscopic method for examining and treating the bile ducts, which are tubes that carry bile from the liver to the small intestine. 

During cholangioscopy, a gastroenterologist inserts a thin, flexible tube called a cholangioscope through the digestive system to the bile ducts. The cholangioscope contains a small camera and light at the end, allowing the gastroenterologist to visualise the bile ducts in detail. 

Cholangioscopy diagnoses and treats various biliary diseases, including bile duct stones, strictures, and cancers. It is a minimally invasive alternative to traditional surgical procedures and can often be performed on an outpatient basis.

Who is Suitable for Cholangioscopy?

Cholangioscopy is suitable for patients who require a more detailed examination of their bile ducts. This includes patients with abnormal liver function tests, suspected biliary strictures or stones, or previously unsuccessful ERCP procedures. Cholangioscopy is also used to diagnose and treat bile duct cancers and other biliary diseases.

What are the Benefits of Cholangioscopy?

One of the main benefits of cholangioscopy is that it allows for a more detailed examination of the bile ducts, leading to more accurate diagnoses and treatment plans. 

In addition, cholangioscopy can help avoid more invasive surgical procedures by allowing for the removal of stones or treatment of strictures through the endoscope.

What are the Types of Cholangioscopy?

There are two types of cholangioscopy: peroral cholangioscopy and percutaneous cholangioscopy.

• Peroral cholangioscopy is performed by passing the cholangioscope through a larger duodenoscope and into the digestive system. The cholangioscope is then passed through the bile ducts to examine and treat abnormalities.
• Percutaneous cholangioscopy is performed by inserting the cholangioscope through a small incision in the skin and directly into the bile ducts. This type of cholangioscopy is typically reserved for patients who cannot undergo peroral cholangioscopy.

Alternative Options to Cholangioscopy

Some of the alternative options to cholangioscopy include:

• Magnetic resonance cholangiopancreatography (MRCP): MRCP is a non-invasive imaging technique that uses magnetic resonance imaging (MRI) to produce detailed images of the bile ducts. It can diagnose biliary diseases, including bile duct stones, strictures, and cancers.
• Endoscopic ultrasound (EUS): EUS is a minimally invasive procedure that uses an endoscope with an ultrasound probe to create images of the bile ducts. It can diagnose and treat biliary diseases, including bile duct stones, strictures, and cancers.
• Percutaneous transhepatic cholangiography (PTC): PTC is a procedure that involves inserting a needle through the skin and into the liver to inject dye into the bile ducts, which can then be visualised with an X-ray. It can diagnose and treat biliary diseases, including bile duct stones and strictures.

What to Do Before a Cholangioscopy?

Before undergoing a cholangioscopy procedure, it is essential to follow the instructions given to you by your doctor. Here are some general guidelines to follow before the procedure:

• Inform your doctor of any medications you take, including over-the-counter medicines and supplements. Before the procedure, your doctor may ask you to stop taking certain medications, such as blood thinners or nonsteroidal anti-inflammatory drugs (NSAIDs).
• Follow any instructions regarding fasting before the procedure. Your doctor may ask you to fast before the procedure to ensure your stomach is empty.
• Arrange for someone to drive you home after the procedure. You will be given sedation during the procedure, which can impair your driving ability.
• Wear comfortable clothing and avoid any jewellery or accessories that may interfere with the procedure.
• Follow any other specific instructions given to you by your doctor, such as taking antibiotics or bowel preparation medication.

What Happens During a Cholangioscopy?

Here is what typically happens during a cholangioscopy procedure:

• You will be given sedation to help you relax and prevent discomfort during the procedure. Most patients will require general anaesthesia.
• The cholangioscope will be inserted through the mouth or nose and passed through the digestive system to the bile ducts. The cholangioscope contains a small camera and light at the end, which transmits images of the bile ducts to a monitor.
• The gastroenterologist will examine the bile ducts and look for any abnormalities, such as stones, strictures, or tumours.
• If abnormalities are found, the gastroenterologist may use the cholangioscope to biopsy, remove stones or treat strictures.
• The procedure typically takes about 30-90 minutes to complete.

What to Do After a Cholangioscopy?

After the cholangioscopy procedure, you will be taken to a recovery area and monitored until the sedation wears off. You will need someone to drive you home, as you may still feel the sedation's effects. It is normal to feel a bit dizzy or nauseous after the procedure. You should avoid eating or drinking anything until the sedation has worn off and follow any instructions given to you by your doctor.

Cholangioscopy Recovery Plan

After a cholangioscopy procedure, it is essential to follow a recovery plan to ensure a smooth and successful recovery. Here are some general guidelines to follow:

• Rest: It is essential to rest for at least 24 hours after the procedure. Avoid strenuous activity, heavy lifting, or exercise during this time.
• Monitor for complications: While complications are rare, it is essential to monitor for signs of infection or bleeding. Contact your doctor immediately if you experience fever, chills, increasing pain, or other concerning symptoms.
• Pain management: After the procedure, you may experience mild discomfort or soreness in the throat or abdomen. Your doctor may recommend over-the-counter pain relievers or medication to manage the pain.
• Diet: Your doctor may provide specific instructions on what to eat or drink after the procedure. Generally, it is recommended that you start with clear liquids and gradually progress to solid foods as tolerated.
• Follow-up appointments: Your doctor may schedule a follow-up appointment to discuss the procedure's results and any necessary further treatment.

You must communicate with your doctor if you have any questions or concerns about the recovery plan. Following these guidelines can help ensure a safe and successful recovery after a cholangioscopy procedure.

Cholangioscopy Risks

Like any medical procedure, cholangioscopy carries some risks. These can include bleeding, infection, and perforation of the bile ducts or surrounding organs. While these risks are rare, discussing them with your doctor before the procedure is essential to understanding the potential complications.

What if Cholangioscopy is Delayed?

If cholangioscopy is delayed, continuing any medications or treatments prescribed by your doctor to manage your symptoms is essential. Delayed procedures may occur due to scheduling conflicts, equipment availability, or other reasons. Your doctor will work with you to reschedule the procedure immediately.

It is essential to communicate with your doctor if your symptoms worsen or if you experience new symptoms while waiting for the procedure. Your doctor may recommend additional tests or imaging to monitor your condition until the procedure can be performed.

What is the Cost of Cholangioscopy?

The cost of cholangioscopy can vary widely depending on the indication.

If you are concerned about the cost of cholangioscopy, you should discuss this with your doctor and insurance provider. Your doctor may be able to provide information on cost estimates or payment plans.