Abstract
After a consensus meeting including experts from all over the country (more than 6 years of experience, at least 50 procedures and their center perform more than 30 procedures/year) several recommendations were issued. Main recommendations: 1-Single-operator digital cholangioscopy is indicated in cases of undetermined biliary strictures in which visual inspection, with or without histology, may change the patient's approach. (Strong recommendation, moderate quality of evidence) 2-In a cholangioscopy for a strictutre of unclear etiology, the optical assessment aspects should be recorded in a standardized report and, according to the endoscopist's visual impression, suggest a malignant or benign etiology. (Strong recommendation, high quality of evidence) 3-When using cholangioscopy regardless of the visual impression, biopsies of the stenosis should be taken (ideally in a number equal to or greater than 6 fragments). (Strong recommendation, moderate quality of evidence) 4-Cholangioscopy with biopsies has a high diagnostic accuracy in the evaluation of undetermined biliary strictures, with a technical success >98% and visual diagnosis with sensitivity / specificity >95%. However, it must be considered that the sensitivity of histological diagnosis is lower (around 70%). (Strong recommendation, high quality of evidence) 5-The single-operator cholangioscopy-assisted lithotripsy is a safe procedure associated with high rates of success. (Strong recommendation, high quality of evidence) 6- Single-operator cholangioscopy-assisted lithotripsy should be reserved for selected cases in which conventional techniques for the treatment of difficult biliary stones have failed. However single-operator cholangioscopy-assisted lithotripsy should be used early in the treatment algorithm to avoid repeated procedures. (Strong recommendation, moderate quality of evidence). 7-Pancreatoscopy can allow the diagnosis of lesions suggestive of malignancy in the pancreatic duct of patients with IPMN of the main duct with high sensitivity and specificity. The group of patients who benefit most from its use are those with a diffusely dilated duct with a diameter greater than 10 mm, and in whom sectional imaging methods and endoscopic ultrasound do not reveal focal lesions. (Weak recommendation, low quality of evidence). 8- The use of intraductal lithotripsy guided by pancreatoscopy in patients with lithiasis in the main pancreatic duct should be reserved for patients with pain and lithiasis greater than 5mm that cannot be removed using conventional techniques. Patients with an excessively distal location in the tail or head may cause increased technical difficulty. (Low recommendation, low quality of evidence)
