Fig. 2. Endoscopic correlation. (A) View of the papillary orifice in attempts at pure freehand cholangioscopy after J maneuvering the scope in the duodenum. (B) “Red out” in the prepapillary common bile duct (CBD) portion obscuring identification of the route. (C) The tip of the balloon catheter improves visual control by gaining some distance from the biliary mucosa, thus facilitating intubation of deeper aspects of the CBD. (D) The balloon catheter is further advanced into the biliary system to improve axis stabilization. Inflation of the balloon is per se not required, although it may be helpful in situations, where the scope slips out to allow for rapid reintubation (compare also the supplementary video sequence; ). (E) Visualization of the hilar region implying procedural completion. Note that neither air/CO2 insufflation nor saline irrigation was needed due to marked biliary dilation.
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