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Aim To evaluate the efficacy and safety of the Spyglass Direct Visualization System in the management of biliary disorders.Methods A comprehensive literature search was conducted using PubMed and EMBASE databases to identify relevant studies published between 2005 and 2011.Search terms included Spyglass, single-operator peroral cholangioscopy, biliary lesion, bile duct stone.Inclusion criteria were reports (prospective or retrospective trials) of Spyglass in patients of biliary lesions with long-term follow up.Data were pooled and analyzed for clinical outcome and complications.