Abstract
In routine clinical situations it is extremely complicated to distinguish benign lesions from malignant biliary lesions. Endoscopic techniques (endoscopic retrograde cholangiopancreatography, endoscopic ultrasonography), as well as non-invasive imaging methods (magnetic resonance cholangiopancreatography, computerised tomography - CT, ultrasonography or endoscopic ultrasonography) often cannot determine the nature of findings in the biliopancreatic system.
Indeterminate stenoses pose a major diagnostic challenge. Oral cholangioscopy (SpyGlass) in both the first and the second (digital) generation helped improve the diagnostic accuracy of findings, especially through direct inspection with the addition of targeted biopsies.
With the development of new methods, probe-based laser endomicroscopy (pCLE) has been used in the market for the last 10 years and, combined with endoscopic retrograde cholangiopancreatography, it has broadened the possibilities of diagnostic yield in resolving indeterminate biliary route stenoses. We present the case of the first clinical application of the approach combining oral cholangioscopy and pCLE in the Czech and Slovak Republics in a patient with suspected stenosis of the extrahepatic bile ducts.