Chik et al: Feasibility of open cholangioscopy with disposable flexible endoscopes
Veterinary Surgery 7, 2024

🔍 Key Findings

Open transcholecystic cholangioscopy was feasible using a 3.8 mm disposable flexible endoscope in all 8 canine cadavers.
Visualization was consistently achieved up to the junction of the hepatic ducts, common bile duct, and cystic duct.
Advancement past the junction was limited by the endoscope diameter (3.8 mm) and anatomical flexure.
The 1.9 mm flexible ureteroscope could visualize the entire biliary tree, including the major duodenal papilla, in a large dog (43.8 kg).
Endoscopic tools (e.g., 3 Fr grasping forceps) could be passed through the working channel only after removing the irrigation line.
Standard biopsy forceps were incompatible with the disposable endoscope's 1.2 mm working channel.
Cadaver study showed no rupture, but clinical extrapolation is limited due to lack of diseased tissue.
Disposable endoscope setup cost (~$6,100) was significantly lower than traditional endoscopy systems (~$75,000–100,000), improving accessibility.

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Chik et al: Feasibility of open cholangioscopy with disposable flexible endoscopes
Veterinary Surgery 7, 2024

🔍 Key Findings

Open transcholecystic cholangioscopy was feasible using a 3.8 mm disposable flexible endoscope in all 8 canine cadavers.
Visualization was consistently achieved up to the junction of the hepatic ducts, common bile duct, and cystic duct.
Advancement past the junction was limited by the endoscope diameter (3.8 mm) and anatomical flexure.
The 1.9 mm flexible ureteroscope could visualize the entire biliary tree, including the major duodenal papilla, in a large dog (43.8 kg).
Endoscopic tools (e.g., 3 Fr grasping forceps) could be passed through the working channel only after removing the irrigation line.
Standard biopsy forceps were incompatible with the disposable endoscope's 1.2 mm working channel.
Cadaver study showed no rupture, but clinical extrapolation is limited due to lack of diseased tissue.
Disposable endoscope setup cost (~$6,100) was significantly lower than traditional endoscopy systems (~$75,000–100,000), improving accessibility.

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Multiple Choice Questions on this study

In Chik 2024 et al., on cholangioscopy feasibility, which factor most limited advancement of the 3.8 mm disposable endoscope into the common bile duct?

A. Insufficient working channel length

B. Obstruction from bile sludge

C. Excessive rigidity of the endoscope

D. Flexure between the cystic and common bile duct

E. Endoscope overheating

Answer: Flexure between the cystic and common bile duct

Explanation: Anatomical flexure and endoscope diameter prevented deeper passage beyond the junction.

In Chik 2024 et al., on cholangioscopy feasibility, what was the key limitation of using standard biopsy forceps through the disposable flexible endoscope?

A. Excessive force caused duct perforation

B. Biopsy forceps were too short for endoscope

C. Working channel diameter was too small

D. Visualization was compromised

E. Biopsy sites bled excessively

Answer: Working channel diameter was too small

Explanation: The 1.2 mm working channel could not accommodate standard radial jaw biopsy forceps.

In Chik 2024 et al., on cholangioscopy feasibility, which endoscope successfully reached the duodenal papilla in at least one cadaver?

A. 2.7 mm rigid endoscope

B. 3.8 mm disposable flexible endoscope

C. 4.5 mm choledochoscope

D. 1.9 mm flexible ureteroscope

E. None were able to reach it

Answer: 1.9 mm flexible ureteroscope

Explanation: The 1.9 mm endoscope reached the duodenal papilla in the largest cadaver (43.8 kg).

In Chik 2024 et al., on cholangioscopy feasibility, what was one major advantage of disposable flexible endoscopes noted by the authors?

A. Shorter procedural time than laparoscopy

B. Compatibility with all endoscopic tools

C. Embedded biopsy imaging

D. Significantly lower startup cost than standard systems

E. Improved access in obstructed ducts

Answer: Significantly lower startup cost than standard systems

Explanation: The disposable endoscope setup cost (~$6,100) was far lower than traditional systems (~$75,000–100,000).

In Chik 2024 et al., on cholangioscopy feasibility, what was the most distal biliary region consistently visualized using the 3.8 mm disposable flexible endoscope?

A. Hepatic lobar ducts

B. Common bile duct at duodenal papilla

C. Confluence of hepatic ducts and cystic duct

D. Intrahepatic bile ducts

E. Major duodenal papilla

Answer: Confluence of hepatic ducts and cystic duct

Explanation: In all eight cadavers, visualization was achievable up to the junction of the hepatic ducts, common bile duct, and cystic duct.

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