When people talk about ERCP, the first reaction is still to think of it as a scope-driven procedure.The scope that advances more smoothly, provides a clearer view, and feels better in hand is often seen as having the advantage.

But as ERCP continues to evolve, the focus of competition is shifting from whether the scope can see the target to whether the entire access pathway can actually support treatment. And as cholangioscopy keeps advancing, the competition is moving even further downstream—to whether the catheter itself can carry more complex therapeutic tasks.

Why?

Because if you look at how the biliary and pancreatic field has developed in recent years, the logic of ERCP competition has already changed quietly but fundamentally. Today, ERCP is no longer just about “reaching the papilla.” It is increasingly about whether a clinician can build a safe, stable, exchangeable, and treatment-ready pathway.

In other words, the real difference is no longer made by the scope body alone, but by the complete pathway capability around access, crossing, exchange, delivery, and treatment completion.

From ERCP to cholangioscopy, and further to advanced single-use diagnostic and therapeutic systems, the competition is following the same direction.

The future will not be defined by a single device alone, but by the engineering capability behind the entire pathway.

That is exactly why an 8-lumen braided tube is such a representative structure.

It is not the final device itself, but it is getting closer and closer to the true source of final device performance. It does not directly define the procedure, but it increasingly affects whether the procedure can be carried out smoothly. It is not the component closest to the physician, but it often plays a decisive role in whether the device feels intuitive, stays stable, and gets the job done.

From this perspective, why is ERCP no longer just a competition between scopes?

Because what clinical practice really needs today is no longer simply an endoscope that can visualize the target. What it needs is a complete system that can create the pathway, deliver the tools, and complete the therapy. And that is exactly why upstream catheters and composite structural components are becoming increasingly important.

Because today’s ERCP is no longer simply about going in and taking a look.

It is expected to manage increasingly complex biliary and pancreatic conditions, from selective biliary cannulation and difficult stone management to stricture diagnosis, drainage and decompression, stent placement, and even direct-visualization lithotripsy or targeted tissue sampling.

The clinical goal has already moved from reaching the site to completing the treatment. And once the goal shifts from observation to therapy, the core of competition naturally shifts from scope performance to pathway performance.

Step One — Can You Get In? Let us begin with the first step: getting in.

In the 2025 WEO (World Endoscopy Organization) guideline on ERCP, difficult biliary cannulation is defined quite clearly. After the papilla is visualized, a case is considered difficult if:

・cannulation attempts last longer than 10 minutes, or

・more than 5 attempts are made, or

・there are 2 or more unintended pancreatic duct entries or pancreatic duct opacifications

This definition makes one point clear. The first hurdle in ERCP is not simply whether the scope reaches the papilla. It is whether the operator can establish the correct pathway quickly, stably, and with minimal trauma.

Because once repeated attempts and repeated adjustments begin, the risk goes up—especially the risk of post-ERCP pancreatitis.

Step Two — Can You Get Through? Next comes the question of whether the pathway can actually be crossed.

For simple cases, the traditional ERCP tool chain may still be enough. But for more complex situations—such as difficult common bile duct stones, impacted stones, complex strictures, cases requiring precise biopsy, or direct-visualization lithotripsy—the challenge is no longer just whether the guidewire gets in.

The real issue is whether all the tools that follow can continue advancing along that pathway.

Whoever can connect the guidewire, cannulation catheter, dilation tools, cholangioscope, lithotripsy tools, stone retrieval devices, and stent delivery system into one continuous pathway is the one who is truly closer to clinical efficiency.

This is also why cholangioscopy, especially single-operator cholangioscopy (SOC), has been used more and more in recent years. Current guidelines already regard SOC as one of the key tools for managing difficult biliary stones and indeterminate biliary strictures.

Step Three — Can It Stay Stable? The next question is whether the pathway can remain stable throughout the procedure.

This is often underestimated. In ERCP, procedural efficiency is usually not determined by a single device parameter, but by whether the entire pathway remains stable.

Once pathway stability is lost, problems quickly appear, including wire loss, difficult device exchange, insufficient distal support, and poor advancement of energy devices or stent delivery systems.

Why is clinical practice putting increasing emphasis on reducing repeated maneuvers, moving earlier to advanced cannulation strategies, and improving one-session treatment completion rates?

At its core, all of these efforts serve the same goal—building a therapeutic pathway with as few interruptions, as little repetition, and as little tissue injury as possible.

That is why ERCP competition is increasingly becoming a competition in system capability.

The scope still matters, of course—but it is more like the entry point.

What really determines the upper limit is the overall capability of the pathway system:

・Can it selectively enter the target bile duct?

・Can it maintain support in tortuous anatomy?

・Can it preserve access during device exchange?

・Can it connect lithotripsy, stone retrieval, biopsy, drainage, and stent delivery into one workflow?

・Can it still complete treatment in more complex cases?

And as clinical practice continues moving toward direct-visualization management of difficult biliary stones, completing more therapeutic steps within a single ERCP session, and advancing single-use cholangioscopy systems, the importance of the composite catheter shaft structure itself becomes much greater.

At that point, the catheter shaft is no longer just a tube that houses the scope. It becomes the structural foundation of the entire therapeutic system.

It must provide trackability, support, instrument access, irrigation and suction capability, imaging integration, steering, and control.

At the same time, it also needs to go deeper, navigate bends more effectively, and minimize kinking, lumen collapse, and performance fluctuation in complex biliary anatomy.

This is exactly why ECO continues to focus on structures such as the 8-lumen braided tube.

From an application perspective, what cholangioscopes and related therapeutic systems require from a composite catheter shaft is no longer simply “one more lumen.” The real challenge is how to integrate multiple functions into one sufficiently stable pathway within a limited outer diameter.

Working channels, imaging-related component channels, steering control, irrigation/suction, and other auxiliary functions are all competing for space inside the same tube. Whoever can integrate these functions at a higher level is closer to building the core structural capability needed for the next generation of biliary interventional devices.

And that is exactly where the value of the 8-lumen braided tube lies.

Its value is not just in having “multiple lumens.”

Its real significance is in maintaining pathway stability, kink resistance, torque transmission, and lumen functionality even under the condition of multifunctional integration.

For systems such as cholangioscopes that must work in narrow, tortuous, and complex anatomy, this is critical.

What truly shapes the clinical experience is often not how many channels a device has in theory. It is whether those channels continue to function after the device reaches deeper anatomy.

Can the instrument still pass smoothly? Does steering still respond in time? Is irrigation still effective? Can the catheter shaft maintain its performance during push and pull maneuvers?

In response to this trend, ECO has moved beyond traditional catheter processing and continued to invest in R&D for multilumen composite catheter technology. ECO has now developed composite tubing with more than ten lumens, as well as high-performance 8-lumen braided tubing.

These products can support a wide range of gastroenterology procedures, including EMR, ESD, ERCP, and EUS.They have also been extended into more advanced applications, including natural orifice robotic surgery.

With the 8-lumen braided tube as a representative structure, ECO continues to make progress in multilumen integration, kink resistance, torque response, navigation through complex anatomy, and overall structural stability.

This means the catheter is no longer just a carrier for functional channels. It is becoming a key enabling structure behind the next generation of gastrointestinal interventional devices.

As clinical demand keeps moving toward deeper access, greater stability, and more complete therapy, the value of multilumen composite catheters will only become more prominent.