The clinic of internal medicine and the clinic of surgery at UKSH, Campus Kiel, are the first Northern German institutions to have introduced digital cholangioscopy and pancreaticoscopy . Meanwhile, more than 20 patients have been treated with this novel diagnostic procedures.
Direct Reflection of the Bile Ducts
While cholangioscopy provides direct imagery of the bile ducts, pancreaticoscopy gives direct insight into the pancreatic duct. However, image quality was pretty pool in the past, as the investigation of the biliary tract and the pancreatic duct was only possible by using a high-resolution endoscopic ultrasound (EUS).
Then, a plastic catheter or cannula was inserted through the ampulla, and radiocontrast injected into the bile ducts and/or pancreatic duct. Fluoroscopy is used to look for blockages, or other lesions such as stones. This method of X-ray imaging is called ERCP (Endoscopic Retrograde Choledocho-pancreaticography). ERCP remains the method of choice for uncomplicated changes in the biliary tract and the pancreatic duct
Outstanding Image Quality With Excellent Maneuverability
Cholangioscopy is primarily used for the treatment of difficult bile duct stones and for the evaluation of indeterminate biliary strictures, i.e. structures that could not be diagnosed as being benign or malignant with sampling techniques such as brush cytology or biopsy. With digital cholangioscopy, a new system is now available combining outstanding image quality with very good maneuverability.
Perfect Extension of Diagnostic and Therapeutic Spectrum
“For the pancreatic and liver cancer centre of our Oncology Centre, direct cholangioscopy and pancreaticography represents an excellent extension of our diagnostic and therapeutic spectrum”, says Dr Mark Ellrich, Head of the Interdisciplinary Endoscopy. “Often, the evaluation of suspicious bottlenecks of the biliary tract has been very difficult and sometimes stressful for the patient without a definitive diagnosis. Now, an immediate diagnosis leading to a targeted therapy has been made possible. Thus, the quality of therapy and care for patients can be significantly improved.”
Quantum Leap in Endoscopy Technology
In addition to the differentiation of unclear constrictions, also a therapy large of gallstones that could not be removed by a standard ERCP has been made possible.
“This quantum leap in endoscopy technology led to setting up a outpatient centre specialised in pancreatic diseases, which complements the existing outpatient clinics for chronic liver and biliary diseases “says Prof Dr Stefan Schreiber, director of the Department of Internal Medicine.
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