Single-operator cholangiopancreatoscopy in pancreatobiliary diseases: clinical experience in a tertiary referral hospital.

BACKGROUND AND AIMS to assess the usefulness, efficacy and safety of single-operator cholangiopancreatoscopy (SOCP) with the SpyGlass™ system for the management of biliopancreatic diseases. METHODS a retrospective analysis of patients undergoing SOCP with the SpyGlass™ between September 2008 and April 2016 was performed. Data was obtained from a prospectively-maintained database at a tertiary referral center. The primary study outcomes were technical and complete endoscopic success of the procedure. Two different SpyGlass™ systems were employed; the former is called legacy and the latter, digital system (DS). RESULTS a total of 107 SOCP procedures in 93 patients performed by a single operator were analyzed. Technical success of the SpyGlass™ examination was achieved in 90/93 (97%) of patients and complete success by resolving the biliopancreatic condition in 82/93 (88%) cases. In indeterminate biliary strictures, a complete success was achieved in 45/52 (85%) of cases. With regard to stone treatment, technical success was achieved in 34/34 (100%) patients and complete success, in 31/34 (91%) cases. Electrohydraulic lithotripsy was applied in 16/34 (47%) of cases. There were a total of 7/93 adverse effects (7.5%). CONCLUSIONS SOCP is a useful and safe technique for the treatment of biliopancreatic diseases with a low rate of adverse effects. The procedure seems technically demanding and dedication is required.

[1]  P. Deprez,et al.  Indications for Single-Operator Cholangioscopy and Pancreatoscopy: an Expert Review , 2019, Current Treatment Options in Gastroenterology.

[2]  T. Itoi,et al.  Cholangioscopy , 2019, ERCP.

[3]  G. Tienhoven,et al.  Modern work-up and extended resection in perihilar cholangiocarcinoma: the AMC experience , 2018, Langenbeck's Archives of Surgery.

[4]  Richard S. Kwon,et al.  Efficacy and Safety of Digital Single‐Operator Cholangioscopy for Difficult Biliary Stones , 2017, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[5]  M. Takenaka,et al.  Prospective evaluation of digital single‐operator cholangioscope for diagnostic and therapeutic procedures (with videos) , 2017, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society.

[6]  R. Shah,et al.  Cholangioscopy and pancreatoscopy , 2017 .

[7]  A. Peixoto,et al.  Peroral cholangiopancreatoscopy with the SpyGlass® system: what do we know 10 years later. , 2017, Journal of gastrointestinal and liver diseases : JGLD.

[8]  S. Pereira,et al.  Pancreatoscopy-Directed Electrohydraulic Lithotripsy for Pancreatic Ductal Stones in Painful Chronic Pancreatitis Using SpyGlass , 2017, Pancreas.

[9]  S. Varadarajulu,et al.  Digital, single-operator cholangiopancreatoscopy in the diagnosis and management of pancreatobiliary disorders: a multicenter clinical experience (with video). , 2016, Gastrointestinal endoscopy.

[10]  S. Varadarajulu,et al.  Improving the diagnostic yield of single-operator cholangioscopy-guided biopsy of indeterminate biliary strictures: ROSE to the rescue? (with video). , 2016, Gastrointestinal endoscopy.

[11]  A. Trindade,et al.  Use of digital cholangioscopy in a dilated bile duct for detection of small symptomatic bile duct stones. , 2016, Gastrointestinal endoscopy.

[12]  A. Sharma,et al.  Usefulness of single-operator cholangioscopy-guided laser lithotripsy in patients with Mirizzi syndrome and cystic duct stones: experience at a tertiary care center. , 2016, Gastrointestinal endoscopy.

[13]  M. Friedrich-Rust,et al.  Intraductal biopsies in indeterminate biliary stricture: Evaluation of histopathological criteria in fluoroscopy- vs. cholangioscopy guided technique. , 2016, Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver.

[14]  T. Korpela,et al.  Long-term results of combined ESWL and ERCP treatment of chronic calcific pancreatitis , 2016, Scandinavian journal of gastroenterology.

[15]  T. Ohtsuka,et al.  Diagnostic and therapeutic single-operator cholangiopancreatoscopy in biliopancreatic diseases: Prospective multicenter study in Japan. , 2016, World journal of gastroenterology.

[16]  V. Muthusamy,et al.  The efficacy of peroral cholangioscopy for difficult bile duct stones and indeterminate strictures: a systematic review and meta-analysis , 2016, Endoscopy International Open.

[17]  J. K. Lee,et al.  SpyGlass cholangioscopy-assisted guidewire placement for post-LDLT biliary strictures: a case series , 2016, Surgical Endoscopy.

[18]  S. Varadarajulu,et al.  Single-operator cholangioscopy and targeted biopsies in the diagnosis of indeterminate biliary strictures: a systematic review. , 2015, Gastrointestinal endoscopy.

[19]  C. Hassan,et al.  Intraductal biliopancreatic imaging: European Society of Gastrointestinal Endoscopy (ESGE) technology review , 2015, Endoscopy.

[20]  U. Arnelo,et al.  ERCP-guided cholangioscopy using a single-use system: nationwide register-based study of its use in clinical practice , 2015, Endoscopy.

[21]  U. Navaneethan,et al.  Comparative effectiveness of biliary brush cytology and intraductal biopsy for detection of malignant biliary strictures: a systematic review and meta-analysis. , 2015, Gastrointestinal endoscopy.

[22]  P. Stevens,et al.  Interobserver agreement for evaluation of imaging with single operator choledochoscopy: what are we looking at? , 2014, Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver.

[23]  R. Kiesslich,et al.  Efficacy of SpyGlass(TM)-directed biopsy compared to brush cytology in obtaining adequate tissue for diagnosis in patients with biliary strictures. , 2014, World journal of gastrointestinal endoscopy.

[24]  D. Fishman,et al.  Holmium-yttrium aluminum garnet laser lithotripsy in the treatment of biliary calculi using single-operator cholangioscopy: a multicenter experience (with video). , 2014, Gastrointestinal endoscopy.

[25]  J. Vargo,et al.  Therapeutic peroral pancreatoscopy: shockwave lithotripsy of pancreatic duct stones under direct vision. , 2013, Gastroenterology.

[26]  P. Draganov,et al.  The Usefulness of SpyGlass™ Choledochoscopy in the Diagnosis and Treatment of Biliary Disorders , 2012, Current Gastroenterology Reports.

[27]  M. Kahaleh.  Spyglass Direct Visualization System , 2012, Clinical endoscopy.

[28]  E. Kalaitzakis,et al.  Diagnostic and therapeutic utility of single-operator peroral cholangioscopy for indeterminate biliary lesions and bile duct stones , 2012, European journal of gastroenterology & hepatology.

[29]  Mihir S. Wagh,et al.  Diagnostic accuracy of conventional and cholangioscopy-guided sampling of indeterminate biliary lesions at the time of ERCP: a prospective, long-term follow-up study. , 2012, Gastrointestinal endoscopy.

[30]  S. Bhandari,et al.  Single-operator cholangioscopy-guided laser lithotripsy in patients with difficult biliary and pancreatic ductal stones (with videos). , 2011, Gastrointestinal endoscopy.

[31]  B. Petersen,et al.  Single-operator cholangioscopy in patients requiring evaluation of bile duct disease or therapy of biliary stones (with videos). , 2011, Gastrointestinal endoscopy.

[32]  G. Rao,et al.  Role of single-operator peroral cholangioscopy in the diagnosis of indeterminate biliary lesions: a single-center, prospective study. , 2011, Gastrointestinal endoscopy.

[33]  S. Chauhan,et al.  Prospective evaluation of the clinical utility of ERCP-guided cholangiopancreatoscopy with a new direct visualization system. , 2011, Gastrointestinal endoscopy.

[34]  M. Parsi.  Peroral cholangioscopy in the new millennium. , 2011, World Journal of Gastroenterology.

[35]  G. Rajesh,et al.  Extracorporeal shock wave lithotripsy and endotherapy for pancreatic calculi—a large single center experience , 2010, Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology.

[36]  F. Kasmin,et al.  Choledochoscopy-assisted intraductal shock wave lithotripsy. , 2009, Gastrointestinal endoscopy clinics of North America.

[37]  G. Gores,et al.  A multivariable model using advanced cytologic methods for the evaluation of indeterminate pancreatobiliary strictures. , 2009, Gastroenterology.

[38]  D. Fishman,et al.  Management of pancreaticobiliary disease using a new intra-ductal endoscope: the Texas experience. , 2009, World journal of gastroenterology.

[39]  B. Petersen,et al.  Peroral Cholangioscopy Guided Stone Therapy - Report of An International Multicenter Registry , 2008 .

[40]  B. Petersen,et al.  Peroral Cholangioscopy (PO) Using a Disposable Steerable Single Operator Catheter for Biliary Stone Therapy and Assessment of Indeterminate Strictures - A Multi-Center Experience Using Spyglass , 2008 .

[41]  B. Petersen,et al.  Biopsy of Indeterminate Biliary Strictures - Does Direct Visualization Help? - A Multicener Experience , 2008 .

[42]  R. Shah,et al.  Transpapillary cholangioscopy-directed lithotripsy in patients with difficult bile duct stones. , 2007, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[43]  D. Pleskow,et al.  SpyGlass single-operator peroral cholangiopancreatoscopy system for the diagnosis and therapy of bile-duct disorders: a clinical feasibility study (with video). , 2007, Gastrointestinal endoscopy.

[44]  Yang K. Chen.  Preclinical characterization of the Spyglass peroral cholangiopancreatoscopy system for direct access, visualization, and biopsy. , 2007, Gastrointestinal endoscopy.

[45]  G. Kang,et al.  Cholangioscopic findings in bile duct tumors. , 2000, Gastrointestinal endoscopy.

[46]  Myung-Hwan Kim,et al.  Tumor vessel: a valuable cholangioscopic clue of malignant biliary stricture. , 2000, Gastrointestinal endoscopy.

[47]  Y. Nimura,et al.  Staging of Biliary Carcinoma: Cholangiography and Cholangioscopy , 1993, Endoscopy.

[48]  Rambocus Ar.  Endoscopic retrograde cholangiopancreatography. , 1979 .

[49]  M. Nakajima,et al.  Direct endoscopic visualization of the bile and pancreatic duct systems by peroral cholangiopancreatoscopy (PCPS). , 1978, Gastrointestinal endoscopy.