Improving Procedural Efficiency in Direct Peroral Cholangioscopy: A Retrospective Analysis of Intubation Time and Success Rates Across Five Techniques.

Background: Direct peroral cholangioscopy (DPOC) offers enhanced visualization and therapeutic capabilities in biliary tract procedures. However, comparative data on intubation methods and procedural efficiency remain limited. This study aimed to evaluate the success rate, complication rate, and intubation time across five different biliary intubation techniques used in DPOC. Methods: This retrospective study analyzed 36 consecutive patients who underwent DPOC between December 2021 and March 2024. Indications included cholelithiasis, cholangiocarcinoma, proximal migration of biliary prostheses, and self-expandable metallic stent (SEMS) occlusion. Five intubation methods were assessed: freehand, freehand with overtube, intraductal balloon, intraductal balloon with overtube, and intraductal balloon with overtube plus SEMS. Primary outcomes were technical success, intubation time, and complications. Results: All 36 procedures achieved successful biliary intubation (100% technical success) with no reported complications (0%). Mean intubation time differed significantly between methods (P < .001), with the shortest time observed in the intraductal balloon group (mean 73.3 seconds) and the longest in the freehand group (mean 202.25 seconds). No significant differences in intubation time were observed across clinical indications (P = .31). Conclusions: DPOC is a safe and effective procedure for various biliary pathologies, with accessory-assisted methods-particularly balloon-based techniques-demonstrating greater procedural efficiency. These findings support broader adoption of DPOC and tailored selection of intubation strategies based on anatomical and clinical context.