Clin Endosc.  2018 Sep;51(5):498-499. 10.5946/ce.2018.067.

The “Bilio-Papillary Z Line”: Proposal for a Novel Quality Indicator of Direct Cholangioscopy

• Zimmer V

• KMID: 2427725
• DOI: http://doi.org/10.5946/ce.2018.067

Abstract

No abstract available.

MeSH Terms

Biliary Tract Surgical Procedures
Catheterization
Duodenoscopy
Constriction, Pathologic
Dilatation
Common Bile Duct
Bile Ducts
Duodenum
Liver
Cholangiography
Mucous Membrane

Figure

• 

  Fig. 1. The “bilio-papillary Z-line” during freehand-intubated direct cholangioscopy (DC) using an ultra-slim upper endoscope (Fujinon EG-530NW; Fujifilm, Düsseldorf, Germany) (A, B) or standard-size endoscope (Fujinon EG590WR; Fujifilm) (C). Apart from adequate scope stabilization in the acute angulation of the duodenum-bile duct axis, comprehensive endoscopic visualization of the bilio-papillary transitional zone may be impeded by prolapsing papillary mucosa (C). Based on the current conceptual framework, technical refinements, such as dedicated cap-assisted DC may become instrumental in the future to flatten abundant papillary mucosa, comparable to, though less aggressive than, endoscopic large balloon dilation (CRE™ Balloon Dilatation Catheter; Boston Scientific, Ratingen, Germany), which is illustrated here in dilation-assisted freehand DC (D).

Reference

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