SpyGlass Cholangioscopy: Biliary Tract Endoscopy
Specialty · Silo Endoscopy · Colombia 2026
Cholangioscopy and Biliary Tract Endoscopy: SpyGlass, ERCP, and Advanced Biliary Diagnosis
Cholangioscopy allows direct visualization of the inside of the common bile duct with a miniscope introduced through the duodenoscope channel — the SpyGlass DS II system completely changes the diagnosis of indeterminate biliary strictures and difficult stones
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GSMED Imaging medical team — biliary pancreatic endoscopy Colombia
Based on: ASGE Technology Review on Cholangioscopy 2024, ESGE Guideline on Cholangioscopy 2023, Chen YK et al. SpyGlass DS meta-analysis 2024 and advanced biliary endoscopy practice in Colombia.
The biliary tract (common bile duct and intrahepatic bile ducts) was for decades a territory that endoscopy could only reach indirectly — through contrast radioscopy in ERCP. Cholangioscopy changed that: it allows direct visualization of the inside of the common bile duct with a 1 mm miniscope introduced inside the duodenoscope channel, obtaining targeted biopsies of suspicious lesions and fragmenting difficult stones with a laser.
1. SpyGlass DS II — the most used cholangioscopy system
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What is SpyGlass DS II
SpyGlass DS II (Boston Scientific) is the most widespread single-operator cholangioscopy system in the world — a catheter with a high-resolution camera at its tip that is introduced through the duodenoscope working channel into the common bile duct. It has its own 1.2 mm channel for accessories (miniature biopsy forceps, laser lithotripsy fiber). A single person operates both endoscopes simultaneously.
→ 1 operator · Direct common bile duct visualization · Biopsy + laser lithotripsy
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What it allows you to do
Targeted biopsies of biliary strictures suspected of malignancy — with greater diagnostic yield than blind brushing cytology in standard ERCP. Intracorporeal laser lithotripsy (holmium or neodymium) of common bile duct stones difficult to extract with a balloon or basket. Direct evaluation of the extent of cholangiocarcinoma in the biliary tract.
→ Stricture biopsy · Difficult stones · Intracorporeal laser
2. Indications for cholangioscopy
| Indication | Why cholangioscopy | Diagnostic yield |
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| Indeterminate biliary stricture | Blind brushing cytology in ERCP has only 30–45% sensitivity for cholangiocarcinoma. SpyGlass-guided biopsy increases sensitivity to 60–75%. | 60–75% sensitivity (vs 30–45% blind ERCP) |
| Difficult common bile duct stones | Stones >2 cm, hard consistency, in patients where the balloon or Dormia basket have failed in previous ERCP. The laser fragments them from the inside under direct vision. | >90% success with SpyGlass laser lithotripsy |
| Cholangiocarcinoma staging | Determines the proximal extent of the biliary tumor — critical for deciding if surgery (hepatectomy with biliary reconstruction) is feasible. | Staging that changes the surgical decision in 30–40% of cases |
In which Colombian hospitals is cholangioscopy with SpyGlass available?
In 2026, cholangioscopy with SpyGlass DS II is available in high-complexity university hospitals and reference interventional gastroenterology clinics in Bogotá, Medellín, and Cali — mainly in centers with active advanced biliary pancreatic endoscopy programs and experience in high-volume ERCP. It is not a first-line procedure and requires an endoscopist with specific training in advanced ERCP and cholangioscopy. GSMED can guide you on the centers and the availability of the equipment.
Duodenoscopes and systems for biliary endoscopy — GSMED Colombia
Olympus TJF-Q190V (duodenoscope for ERCP and cholangioscopy) with biliary pancreatic accessories — authorized distributors.
Related articles
Sources
- ASGE. Technology Review on Cholangioscopy. asge.org. 2024. ASGE 2024
- ESGE. Guideline on Cholangioscopy. esge.com. 2023. ESGE 2023
- Chen YK et al. SpyGlass DS II — meta-analysis of diagnostic accuracy. Endoscopy. 2024. Chen 2024
