Cholangioscopy: A Practical Guide and Atlas

By Shyam Menon, Venkata Lekharaju, Christopher Wadsworth and 2 more

This book presents the latest approaches to cholangioscopy and covers recent innovations in single-operator cholangioscopy platforms, which have evolved from fibre-optic technology to digital endoscopes and have significantly advanced the management of biliary disease.

The first part presents the development of cholangioscopy and hepatobiliary anatomy and then goes on to discuss the indications for this technique. With dedicated chapters on each stage of the technique, the book subsequently covers patient preparation and nursing issues, set-up, and different types of cholangioscopy.

This book offers a highly topical resource, and addresses the technical challenges related to the procedure, including the different systems available. Accompanied by an extensive library of videos and images, it represents a unique and novel resource for all advanced biliary endoscopists.

• Language: English
• Publisher: Springer
• Release date: Sep 11, 2019
• ISBN: 9783030272616

Book preview

Shyam Menon, Venkata Lekharaju, Christopher Wadsworth, Laura Dwyer and Richard Sturgess

Cholangioscopy

A Practical Guide and Atlas

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Shyam Menon

Department of Gastroenterology, New Cross Hospital, The Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK

Venkata Lekharaju

Department of Gastroenterology, Arrowe Park Hospital, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK

Christopher Wadsworth

Department of Gastroenterology, Hammersmith Hospital, Imperial College London, London, UK

Laura Dwyer

Department of Gastroenterology, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK

Richard Sturgess

Department of Gastroenterology, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK

ISBN 978-3-030-27260-9e-ISBN 978-3-030-27261-6

https://doi.org/10.1007/978-3-030-27261-6

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Preface

The book and videos have been specifically developed to encompass the team involved in delivering cholangioscopy and we feel that it will be of value to nurses assisting in cholangioscopy and trainees, in addition to practising hepatobiliary endoscopists. The online videos are integral to the book and focus on the practical aspects of assembling and using the system, with video examples of the application of cholangioscopy in different settings.

Shyam Menon

Venkata Lekharaju

Christopher Wadsworth

Laura Dwyer

Richard Sturgess

Wolverhampton, UKWirral, UKLondon, UKLiverpool, UKLiverpool, UK

Contents

1 Introduction and History of Cholangioscopy 1

Mother-Daughter/​Dual-Operator Cholangioscopy 2

Single-Operator Cholangioscopy 3

Direct Cholangioscopy with Ultra-slim Endoscope 4

Hepatobiliary Anatomy 5

References 9

2 Indications for Cholangioscopy, Pre-procedural Patient Care and Preparation 11

Indications 11

Pre-procedural Patient Care and Preparation 12

Consent 12

Pre-assessment 13

Procedural Considerations 15

Post-procedural Care 18

ERCP and Pacemakers/​Defibrillators 18

Example Patient Information Leaflet 19

References 23

3 Single Operator Cholangioscopy 29

Cholangioscopy Technique 30

Lithotripsy 32

Electrohydraulic​ Lithotripsy (EHL) 32

Laser Lithotripsy 35

Biopsies 36

Suction 36

Complications 40

Pancreatoscopy 40

References 41

4 Direct Cholangioscopy 45

Equipment and Technique 46

Developments/​Future Applications 48

References 48

Video A:​ Spyglass Cholangioscopy Introduction and Set Up 51

Video B:​ Spyglass Cholangioscopy Video Transcript 59

List of Figures

Fig. 1.1 Couinaud’s classification of liver segments. In this anterior view of the liver, LL (left lateral, liver segments 2 and 3) and LM (left medial: liver segment 4) comprise the left lobe. RA (right anterior: segments 5 and 8) and RP (right posterior: segments 6 and 7) comprise the right lobe of the liver7

Fig. 1.2 Couinaud’s classification of liver segments. In this posterior view of the liver, LL (left lateral, liver segments 2 and 3) and LM (left medial: liver segments 1and 4) comprise the left lobe. RA (right anterior: segments 5 and 8) and RP (right posterior: segments 6 and 7) comprise the right lobe of the liver8

Fig. 1.3 Anatomy of the biliary system in relation to Couinaud’s liver segments. The common bile duct (CBD) extends into the common hepatic duct (CHD), which then splits into the right (R) and left (L) main ducts. The right anterior (RA) and the right posterior (RP) segmental ducts take off from the right main duct to provide sectoral drainage to segments 6 and 7 (RA) and segments 5 and 8 (RP). Sectoral ducts 1 and 4 (LM: left medial) and 2 and 3 (LL: left lateral) provide drainage to the left lobe of the liver9

Fig. 3.1 Small intrahepatic duct stone (arrow)34

Fig. 3.2 Ductal stone (arrow) accessed via a T-tube in a patient post antrectomy for gastric cancer and