Episode 37: The one where I talk about Cholangioscopy
From The Interventional Endoscopist by Mankanwal Sachdev
November 4, 2025 · 45 min · Episode 37
About this episode
Mankanwal Sachdev discusses the advancements and techniques in cholangioscopy and its impact on diagnosis and therapy.
In this deep-dive, Mankanwal Sachdev explores how cholangioscopy moves us from fluoroscopic silhouettes to direct mucosal visualization—and why that changes diagnosis and therapy across indeterminate strictures, PSC dominant lesions, and difficult stones. We walk through the current platform landscape (SpyGlass™ DS2, eyeMAX™, and Dragonfly™), practical biopsy technique to improve yield, and real-world lithotripsy choices (EHL vs Holmium laser) with a focus on workflow, cost, and verification of clearance. We also look ahead to AI-assisted interpretation, robotic/telerobotic control, and how training is evolving with ESGE 2025 standards and ASGE/ACG guidance. If you’re building or refining a pancreatobiliary program, this episode offers an evidence-based framework you can put to work tomorrow. Key takeaways: Use cholangioscopy when results will change management; pair with EUS for maximal diagnostic yield. Standardize biopsy protocols and specimen handling with pathology. Choose energy based on stone density, access, and resources; confirm clearance by direct inspection. Build a training pathway (simulation + supervised volume) and consider tiered credentialing. Selected…
People in this episode
Host: Mankanwal Sachdev
Topics covered
- cholangioscopy
- diagnosis
- therapy
- biopsy technique
- lithotripsy
- AI-assisted interpretation
- training pathways
Keywords
- cholangioscopy
- biopsy technique
- lithotripsy
- AI-assisted interpretation
- pancreatobiliary program
- EUS
- training pathways
Mentioned in this episode
Organizations: ESGE, ASGE, ACG
Products: SpyGlass™ DS2, eyeMAX™, Dragonfly™
Books & works: Amaral 2023 laser vs EHL, Mauro 2023 review
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