Commentary

Obtaining tissue from the biliary tract using standard biopsy forceps may be cumbersome. The authors present a tunneling technique, wherein a dilating catheter is first inserted first into the bile duct, and then the forceps is pushed through the “tunnel” catheter into the bile duct. This technique enables easy access by forceps into the biliary tract, as compared with the free biopsy cannulation technique, which is quite difficult as the forceps tip is stiff and has a 70 – to 90-degree angle from the duodenoscope.

In our own practice we use a stent-pushing catheter as the means of access (the “mini-overtube” bile duct access technique), to obtain tissue from the bile ducts, and to perform therapeutic interventions such as: (a) extraction of proximally migrated stents; (b) manipulation of multiple wires; (c) direct cholangioscopy using fiberoptic cable; (d) photodynamic therapy; and (e) passage through complex biliary strictures [1] [2] [3].

Publication History

Article published online:
24 June 2020

• References

• 1 Olano C, Mönkemüller K. Novel ERCP technique using a pushing catheter as a “mini-overtube” to remove a migrated metal stent from the bile duct. Endoscopy 2014; 46: E534-E535
• 2 Pereira GB, Gutierrez JP, D'Assuncao M. et al. Utility of a stent pusher catheter as a “mini-overtube” in the endoscopic management of post-liver transplant biliary strictures. Endoscopy 2015; 47: E587-E589
• 3 Ramesh J, Wilcox CM, Mönkemüller K. Mini direct cholangioscopy and direct targeted bile duct biopsies using a laser fiber through a biliary catheter. Endoscopy 2013; 45: E127-E128