Bile duct imaging - ERCP techniques and visuals

ERCP cholangioscopy image reference guide

The intent of this reference guide is to help familiarize physicians with the appearance of biliary findings. Images of bile, cystic and hepatic ducts are presented to illustrate and familiarize the user with the appearance of a healthy, normal ducts and to contrast with the appearance of the biliary tree in a variety of pathologic states. Images featuring various types of benign and malignant conditions are represented in this guide, including strictures, villous lesions, stone disease, select SpyGlass accessories in action, and more.

Normal ducts Stone disease Villous lesions Malignant disease Filling defects Pancreatoscopy Liver transplant Epithelial bridge Portal vein thrombosis and cholangiopathy

Normal ducts

Clinical image of normal vascular patterns.

Normal vascular patterns (SpyScope™ DS II)

Common hepatic duct (SpyScope DS II)

Cystic duct take-off (SpyScope DS II)

Intrahepatic ducts (SpyScope DS II)

Intrahepatic ducts (SpyScope DS II)

Clinical image of shallow decompressions.

Shallow decompressions (SpyScope DS II)

Clinical image of Normal villous pattern (DS I).

Normal villous pattern (SpyScope™ DS)

Clinical image of Normal common bile duct (DS I).

Normal common bile duct (SpyScope DS)

Clinical image of Normal cystic duct common bile duct junction (DS I).

Normal cystic duct common bile duct junction (SpyScope DS)

Clinical image of Normal common hepatic duct (DS I).

Normal common hepatic duct (SpyScope DS)

Clinical image of Normal deep left hepatic duct (DS I).

Normal deep left hepatic duct (SpyScope DS)

Clinical image of Normal deep right heptic duct (DS I).

Normal deep right heptic duct (SpyScope DS)

Stone disease

Stone in common bile duct (SpyScope DS II)

Clinical image of electrohydraulic lithotripsy.

Electrohydraulic lithotripsy probe (SpyScope DS II)

EHL in action (SpyScope DS II)

Clinical image of pancreatic duct stone.

Pancreatic duct stone (SpyScope DS II)

Clinical image of EHL for pancreatic stone.

Lithotripsy for pancreatic stone (SpyScope DS II)

SpyGlass™ Retrieval Basket (SpyScope DS II)

Clinical image of SpyGlass Retrieval Basket for stone fragment.

SpyGlass Retrieval Basket (SpyScope DS II)

SpyGlass Retreival Basket (SpyScope DS II)

Cystic duct stone (SpyScope DS)

Intrahepatic stone (SpyScope DS)

Clinical image of Homium laster lithotripsy (DS I).

Homium laser lithotripsy (SpyScope DS)

Villous lesions

Villiform formation (SpyScope DS)

Villous lesion (SpyScope DS II)

Malignant disease

Characteristics of a malignant stricture¹:

Luminal narrowing
Nodularity
Exophytic vascular tissue
Increased vascularity

Clinical image of characteristics of a malignant stricture.

Characteristics of a malignant stricture (SpyScope DS II)

Clinical image of cholangiocarcinoma extension.

Asymmetric malignant appearance (SpyScope DS II)

SpyBite™ Max Biopsy Forceps (SpyScope DS II)

SpyBite Max Biopsy Forceps (SpyScope DS II)

Clinical image of increased vascularity.

Increased vascularity (SpyScope DS II)

Villous lesion (SpyScope DS II)

Filling defects

Filling defects showing surgical staples (SpyScope DS)

Clinical image of Filling defects showing surgical staples II (DS I).

Filling defects showing surgical staples II (SpyScope DS)

Clinical image of Desquamated epithelium (DS I).

Desquamated epithelium (SpyScope DS)

Clinical image of Desquamated epithelium II (DS I).

Desquamated epithelium II (SpyScope DS)

Stone debris (SpyScope DS)

Pancreatoscopy

Normal pancreas (SpyScope DS II)

Pancreatic duct (SpyScope DS II)

Clinical image of chronic calcific pancreatitis.

Chronic calcific pancreatitis (SpyScope DS II)

Clinical image of pancreatic duct biopsies.

Pancreatic duct biopsies (SpyScope DS II)

IPMN* mucin (SpyScope DS II)

IPMN* (SpyScope DS II)

Main duct IPMN* prominent villi with blood vessel (SpyScope DS II)

Clinical image of pancreatic duct and side branches.

Pancreatic duct and side branches (SpyScope DS II)

Liver transplant

Clinical image of Biliary anastamosis four years (DS I).

Biliary anastamosis four years (SpyScope DS)

Clinical image of Biliary anastamosis six months (DS I).

Biliary anastamosis six months (SpyScope DS)

Clinical image of Biliary anastamosis 18 months intrahepatic stones (DS I).

Biliary anastamosis 18 months intrahepatic stones (SpyScope DS)

Clinical image of Biliary anastamosis two years (DS I).

Biliary anastamosis two years (SpyScope DS)

Clinical image of Native cystic duct biliary anastamosis four years (DS I).

Native cystic duct biliary anastamosis four years (SpyScope DS)

Epithelial bridge

Epithelial bridge (SpyScope DS)

Portal vein thrombosis & cholangiopathy

Clinical image of Portal vein thrombosis and cholangiopathy (DS I).

Portal vein thrombosis and cholangiopathy (SpyScope DS)

Want more cholangisocopy image resources?

Visit the EDUCARE platform to access addtional resources to help prepare you for your next ERCP with cholangioscopy.

Go to resources

1. Kahaleh M, Gaidhane M, Shahid HM, et al. Digital single-operator cholangioscopy interobserver study using a new classification: the Mendoza Classification (with video). Gastrointest Endosc. 2022;95(2):319-326. doi:10.1016/j.gie.2021.08.015

Indications, Safety, and Warnings for SpyScope™ DS II

CAUTION: The law restricts these devices to sale by or on the order of a physician. Indications, contraindications, warnings, and instructions for use can be found in the product labelling supplied with each device or at www.IFU-BSCI.com. Products shown for INFORMATION purposes only and may not be approved or for sale in certain countries. This material not intended for use in France.

Images provided courtesy of Dr. Isaac Raijman.

*Intraductal Papillary Mucinous Neoplasm

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