Cholangioscopy

Patient Information Leaflet

Endoscopy

You should read this information with the Endoscopic Retrograde Cholangio pancreatography (ERCP).

What is cholangioscopy?
Cholangioscopy is a procedure to examine the bile duct. It is an add-on test to ERCP and is done using a cholangioscope. This is an ultrathin endoscope that can be passed through an ERCP endoscope channel.

What are the benefits?
1. Biopsies of a stricture (narrowing) within the bile duct.

Benign scar tissue or a tumour can cause stricture in the bile duct. The cholangioscope can be put into the bile duct to see the stricture area. The cholangioscope has a mini-channelthrough which a mini-biopsy forceps can be introduced. This enables targeted biopsies of the stricture, which allows accurate diagnosis of the cause of the stricture.

2. Treatment of large bile duct stones
The ERCP endoscopy procedure is usually performed to remove gallstones in the bile duct. Large stones are harder to remove because of narrowing at the lower end of the bile duct. The cholangioscope can be advanced directly into the bile duct. A further probe is passed through the cholangioscope to perform lithotripsy, breaking the large stones into smaller fragments. This process is called electrohydraulic lithotripsy (EHL). The smaller stone fragments can then be removed with conventional ERCP methods (balloon and/or basket). The team at the Dudley Group NHS Trust offers EHL as a treatment option for difficult to treat bile duct stones.

Follow-up procedures or clinic appointments will be arranged. The ERCP procedure will most likely take longer due to the addition ofcholangioscopy. Additional doses of sedative and analgesia medications are given.

Are there any significant risks?
The cholangioscopy procedure involves risks like those of ERCP like bleeding, pancreatitis, and cholangitis (infection of the bile duct). To reduce the risk of pancreatitis, you will be given diclofenac in a rectal suppository unless there is any reason not to, and intravenous fluid at the end of the procedure. To reduce the risk of cholangitis, you may be given an injection dose of antibiotics and may be given a course of oral antibiotics to take home.

Further general information
National Institute for Health and Care (NICE) has published an Interventional procedure guidance on EHL in May 2021. Please refer to the information sheet “NICE Information for the public” for further guidance. Cholangioscopy was introduced at Dudley in Spring 2026, and so is relatively new. It is performed by a limited number of consultants who have completed additional training. Outcomes are carefully monitored. Please ask your consultant if you have further questions relating to this procedure.

If you have any questions, or if there is anything you do not understand about this leaflet, please contact Russells Hall Hospital on 01384 456111.

If you have any feedback on this patient information leaflet, please email dgft.patient.information@nhs.net.

Date originated: March 2026. Next review: June 2028. Version 1.