A snare-assisted peroral direct choledochoscopy and pancreatoscopy using an ultra- slim upper endoscope: A case series study Yong-hui Huang, Hong Chang,

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A snare-assisted peroral direct choledochoscopy and pancreatoscopy using an ultra- slim upper endoscope: A case series study Yong-hui Huang, Hong Chang, Wei Yao, Yao-peng Zhang, Ke Li, Ye Wang Digestive and Liver Disease Volume 49, Issue 6, Pages 657-663 (June 2017) DOI: 10.1016/j.dld.2017.01.150 Copyright © 2017 Editrice Gastroenterologica Italiana S.r.l. Terms and Conditions

Fig. 1 A snare was tightened around the end of the bending section of the scope. The arrow indicates the dragging direction of the endoscopic snare. Digestive and Liver Disease 2017 49, 657-663DOI: (10.1016/j.dld.2017.01.150) Copyright © 2017 Editrice Gastroenterologica Italiana S.r.l. Terms and Conditions

Fig. 2 The snare was pulled slightly as a fulcrum to prevent the endoscope from being pushed too far downward into the duodenum and to make insertion of the endoscope easier. Digestive and Liver Disease 2017 49, 657-663DOI: (10.1016/j.dld.2017.01.150) Copyright © 2017 Editrice Gastroenterologica Italiana S.r.l. Terms and Conditions

Fig. 3 (A) A cholangiogram showing a polypoid mass in the common hepatic duct. (B) A cholangioscopic view showing an intraductal polypoid mass. Digestive and Liver Disease 2017 49, 657-663DOI: (10.1016/j.dld.2017.01.150) Copyright © 2017 Editrice Gastroenterologica Italiana S.r.l. Terms and Conditions

Fig. 4 (A) A cholangiogram showing a large common bile duct stone. (B) Peroral direct cholangioscopy of a large common bile duct stone. (C) A cholangioscopic view of CBD stone fragmentation using laser lithotripsy. Digestive and Liver Disease 2017 49, 657-663DOI: (10.1016/j.dld.2017.01.150) Copyright © 2017 Editrice Gastroenterologica Italiana S.r.l. Terms and Conditions

Fig. 5 Large common bile duct stones. (Note: the Chinese characters mean “warning: this is not used for diagnosis.”) (A) Huge stones shown by endoscopic retrograde cholangiography. (B) Ultrathin endoscopic image. (C) Insertion of the ultrathin endoscope into the biliary tract. (D) Laser lithotripsy. Digestive and Liver Disease 2017 49, 657-663DOI: (10.1016/j.dld.2017.01.150) Copyright © 2017 Editrice Gastroenterologica Italiana S.r.l. Terms and Conditions

Fig. 6 Large common bile duct stones. (Note: the Chinese characters mean “warning: this is not used for diagnosis.”) (A) Large common bile duct stones shown by endoscopic retrograde cholangiography. (B) Papillary balloon dilatation. (C) Insertion of the ultrathin endoscope into the bile duct. (D) Laser lithotripsy. (E) Post-laser lithotripsy. (F) Direct stone removal with a small, specially made, mesh basket. Digestive and Liver Disease 2017 49, 657-663DOI: (10.1016/j.dld.2017.01.150) Copyright © 2017 Editrice Gastroenterologica Italiana S.r.l. Terms and Conditions

Fig. 7 Oral direct choledochoscope. (Note: the Chinese characters mean “warning: this is not used for diagnosis.”) (A) Duodenoscopic balloon dilatation. (B) Papillary opening post-ultrathin endoscopic dilatation. (C) Insertion of the ultrathin endoscope into the bile duct after pulling the snare. (D) Cystic duct opening. (E) Extrahepatic bile duct stones. Digestive and Liver Disease 2017 49, 657-663DOI: (10.1016/j.dld.2017.01.150) Copyright © 2017 Editrice Gastroenterologica Italiana S.r.l. Terms and Conditions