Applications

1673 – Single operator, single use, peroral cholangiopancreatoscopy for diagnosis of indeterminate biliary strictures and removal of difficult biliary stones

Find out about the service or technology in this application and the medical condition it addresses. You can also view the application documents, the deadlines for providing consultation input and the outcome of the application when the MSAC process is complete.

  • Status Complete
  • Type New application
  • Pre-PASC consultation Not applicable
  • Pre-MSAC consultation Closed
  • Outcome Supported

Application details

Reason for application

New MBS item.

Service or technology in this application

Single operator, single use, peroral cholangiopancreatoscopy (POCPS) enables high resolution imaging and therapy during an endoscopic retrograde cholangiopancreatography (ERCP) procedure. The POCPS system consists of a catheter which is passed through the standard working channel of the ERCP duodenoscope, directly into the pancreatic and biliary ducts. This system is considered to produce high-definition, direct endoscopic visualisation of the pancreatobiliary system.

This application focusses on two key indications for POCPS:

  • Diagnostic application: diagnosis of indeterminate biliary strictures; and
  • Therapeutic application: removal of difficult biliary stones.

Type: Diagnostic and therapeutic

Medical condition this application addresses

Indeterminate biliary strictures

A biliary stricture is an abnormal narrowing of the bile duct, obstructing the passageway that carries bile from the liver to the bowel. Various disorders can result in the narrowing of the biliary ducts. The most common benign conditions include:

  • Latrogenic (injury from surgical procedures)
  • Primary sclerosing cholangitis (chronic inflammatory disease of the bile ducts)
  • Chronic pancreatitis (inflammation of the pancreas)

The most common malignant conditions include cholangiocarcinoma (bile duct cancer), which has an incidence of 4.6 per 100,000 in Australia.

Difficult biliary stones

Gallstones are one of the most common diseases worldwide, with an estimated prevalence of 25-30% in Australians over the age of 50 years. In 10-18% of these patients, a gallstone will migrate from the gallbladder to the biliary ducts. Less frequently, stones will originate in the biliary ducts themselves. Biliary stones may be difficult to remove if they are impacted, lodged behind strictures, large in size (>15mm in diameter) or located in regions of the biliary tree which are difficult to target endoscopically.

Consultation survey and deadlines

  • PASC consultation: Not applicable
  • MSAC consultation: Closed11 February 2022

Meetings to consider this application

  • PASC meeting: 12 to 13 October 2021
  • ESC meeting: 10 to 11 February 2022
  • MSAC meeting: 31 March to 1 April 2022