Table 2.

Types of choledochoscopy

Type of choledochoscopy	Advantages	Disadvantages
Peroral (endoscopic)	Natural orifice	(1) Technical expertise; (2) Sedation or anesthesia; and (3) Not possible in patients with previous gastric resections or Roux-en-Y gastric bypass
Percutaneous transhepatic (interventional radiology)	(1) Shorter scope length; (2) Repeated with ease; and (3) Therapeutic interventions	(1) Need dilated intra-hepatic ducts; and (2) Risk of bleeding, bile leak, tumor seeding, biliary fistula and skin excoriation
Percutaneous transenteric via access loop (interventional radiology, surgical)	(1) Shorter scope length; (2) Repeated with ease; (3)Therapeutic interventions; (4) Ductal dilatation not necessary; and (5) In patients with RPC	(1) Previous access loop creation; and (2) Risk of small bowel injury, peritonitis, biliary fistula and skin excoriation
Intra-operative transcystic (surgical)	(1) Avoid CBD incision; (2) Therapeutic interventions; (3) Can document CBD clearance; and (4) It can be done laparoscopically	(1) The spiral valve of Heister; (2) Anatomy of the cystic duct; (3) Size of the cystic duct; (4) Need thin scopes (3 mm); (5) Technical expertise; and (6) Risks of bleeding, bile leak
Intra-operative transcholedochal (surgical)	Most direct access	(1) Need dilated extra-hepatic biliary system; (2) Risk of bleeding, bile leak; (3) Can put an internal stent; and (4) Can put T tube

RPC: Recurrent pyogenic cholangitis; CBD: Common bile duct.