Usability of a novel cholangiopancreatoscope for tumor detection and stone management.

Background and Aims: Peroral cholangiopancreatoscopy (POCP) is increasingly used in complex ERCP but remains limited by small working channels and maneuverability challenges. This case series describes early user experience with a novel single-use POCP system for evaluation of indeterminate biliary strictures and electrohydraulic lithotripsy (EHL) of pancreatic and biliary stones. Methods: A case series included individuals undergoing evaluation for indeterminate biliary strictures and complex stone management. Procedures were evaluated for technical success, usability (Likert scale), diagnostic yield, and adverse events (AEs). Results: Twelve patients were included. Among the 9 who underwent cholangioscopy-directed biopsy samples, all provided adequate tissue. Of 6 malignancies, none were diagnosed by brush cytology, whereas cholangioscopy-directed biopsy samples were diagnostic in 4 of 5 cases of cholangiocarcinoma and 1 case of hepatocellular carcinoma. In all 3 stone cases, a 4.5F (catheter/probe size unit; 1F = 0.33 mm) EHL probe was successfully advanced, achieving complete stone clearance in a single session. Five endoscopists performed the procedures, reporting high Likert scores for pushability, tip control, device passage, and image quality. No periprocedural AEs were noted. Conclusions: In this limited single-center, noncomparative experience, the system enabled tissue sampling and EHL with reported ease of use. These preliminary findings should be interpreted cautiously and in the context of standard ERCP risks, including pancreatitis, infection, perforation, and cholangitis.