Direct cholangioscopy and pancreatoscopy Richard Kozarek, MD a, * , Tadashi Kodama, MD b , Yoshihide Tatsumi, MD c a Section of Gastroenterology, Virginia Mason Medical Center, 1100 Ninth Avenue Seattle, WA 98101, USA b Department of Gastroenterology, Kitade Hospital, 728–4 Takara Yukawa-cho, Gobo, Wakayama, Japan c Department of Gastrointestinal Diseases, Matsushita Health Care Center, 5–55 Sotojima-cho, Moriguchi, Osaka, Japan Direct cholangiopancreatoscopy has played a minor role in the diagnosis and treatment of pancreaticobiliary disorders, initially because of instrument fragility and suboptimal imaging, and later because of improvements in noninvasive and semi-invasive imaging techniques. Digital scopes provide superior images and hold the promise of increased application and improved durability. Are we there yet? In other words, has direct cholangioscopy or pancreatoscopy fulfilled the prophecy of improved diagnosis and treatment of pancreaticobiliary disorders [1]? Or have improvements in other imaging modalities (pancreas protocol CT, magnetic resonance cholangiopancreatography [MRCP], or endoscopic ultrasound [EUS]) surpassed the technologic refinements developed in small-caliber endo- scopes used in the pancreaticobiliary tree [2,3]? This article briefly reviews historical and currently marketed pancreaticocholangioscopes. The coauthors detail potential leapfrog technology with a description of a yet-to-be-marketed electronic pancreatoscope. Whether called daughter-, baby-, or miniscopes, small-caliber endoscopes for application in the pancreaticobiliary tree were initially developed in the 1970s and became popular again in the late 1980s [4–8]. Their use was and is still limited to large pancreaticobiliary centers. The technology is labor intensive. It requires multiple light sources, additional support staff, and the presence of a second endoscopist within the endoscopic retrograde cholangiopancreatography (ERCP) suite. Another reason this technology never became generally used is its expense in 1052-5157/03/$ – see front matter D 2003 Elsevier Inc. All rights reserved. doi:10.1016/S1052-5157(03)00105-3 * Corresponding author. E-mail address: gasrak@vmmc.org (R. Kozarek). Gastrointest Endoscopy Clin N Am 13 (2003) 593 – 607