Efficacy and Safety of Balloon Endoscopy-Assisted Peroral Cholangiopancreatoscopy (POCPS) Using a Novel 9Fr Cholangioscope in Patients With Surgically Altered Anatomy: A Dual-Center Retrospective Study (With Video).

Peroral cholangiopancreatoscopy (POCPS) is established for diagnosis and treatment of pancreatobiliary diseases in patients with normal anatomy, but has been difficult to perform in patients with surgically altered anatomy (SAA) because conventional cholangioscope systems cannot pass through the working channel of balloon endoscopes. The novel 9Fr cholangioscope (eyeMAX 9Fr; Micro-Tech) has a 3.2-mm outer diameter, enabling passage through the 3.2-mm working channel of short-type balloon endoscopes and allowing through-the-channel POCPS during balloon endoscopy-assisted ERCP (BE-ERCP) without scope exchange. We retrospectively evaluated 38 consecutive BE-POCPS procedures using the eyeMAX 9Fr in patients with SAA at two tertiary centers in Japan. Indications included biliary stone (n = 31), pancreatobiliary stricture (n = 4), pancreatic stone (n = 1), cystic duct selection (n = 1), and migrated stent retrieval (n = 1). Technical success was achieved in all 38 cases (100%) across five reconstruction types using both single-balloon and double-balloon endoscopes. For lithotripsy (n = 32), stone fragmentation was successful in all cases, with single-session complete stone clearance in 53.1%. For stricture evaluation (n = 4), visual assessment-final diagnosis concordance was 75.0% (3/4) and biopsy adequacy rate was 75% (3/4); biopsy-final diagnosis concordance was 100% among adequate specimens (3/3). Adverse events occurred in three cases (7.9%), including lithotripsy-related bile duct mucosal injury/bleeding (n = 2), and scope-related small bowel perforation (n = 1). BE-POCPS using the eyeMAX 9Fr is a feasible and safe approach enabling direct visualization, targeted biopsy, and lithotripsy in SAA patients without scope exchange.