Clinical impact of digital cholangioscopy in management of indeterminate biliary strictures and complex biliary stones: a single-center study

Abstract

Aims: Endoscopic management of indeterminate strictures and complex stones remains a challenge, for which the latest generation single-operator digital cholangioscope (SpyGlass DS) has shown promising results. We aimed to study the clinical impact of single-operator digital cholangioscope at our tertiary academic center. Methods: We retrospectively reviewed all digital cholangioscopies performed from June 2015 to May 2018. Patient characteristics, procedure characteristics, and post-procedural patient outcomes were recorded. Results: A total of 50 patients (26 men, average age 61.4 years) underwent 67 procedures. Indications were biliary stones (21/50, 42%), strictures and primary sclerosing cholangitis surveillance (22/50, 46%), and miscellaneous (7/50, 14%). The average procedure time was 82 ± 29 min (99.5 min for stones and 74.2 min for strictures). Stone clearance was achieved in 19/21 (90.47%) cases, with electrohydraulic lithotripsy employed in 16/21 and repeat cholangioscopy necessary in 9/21. Malignant strictures (10) were differentiated from benign (12) in all cases both in patients with primary sclerosing cholangitis (9) and in those without (13), based on visual cholangioscopic features (sensitivity and specificity 100%), single-operator digital cholangioscope–directed biopsies (sensitivity 60% and specificity 100%), and brush cytology (sensitivity 37.5% and specificity 100%). Complications included one post-sphincterotomy bleeding and one post-procedural cholangitis despite antibiotic prophylaxis, but no procedure-related mortality. Conclusion: Single-operator digital cholangioscope had a high success rate and a low rate of complications for management of indeterminate strictures and difficult biliary stones. Visual cholangioscopic features of biliary strictures had excellent diagnostic accuracy, and targeted biopsies outperformed brush cytology. Early implementation of cholangioscopy for select indications leads to successful patient outcomes and reduces diagnostic delays, cost, and risks of repeat endoscopic retrograde cholangiopancreatographies.

Efficacy and Safety of Digital Single-Operator Cholangioscopy in the Diagnosis of Indeterminate Biliary Strictures by Targeted Biopsies: A Systematic Review and Meta-Analysis

“…Furthermore, 132 articles were excluded, because these did not report the diagnostic accuracy of DSOC by SpyBite in the diagnosis of IDBS. The remaining 54 studies were evaluated, and a total of 11 studies [10][11][12][13][14][15][16][17][18][19][20] that satisfied the selection criteria, which involved 323 patients for SpyBite biopsy (SB), were included in the present meta-analysis ( Figure 1).…”

“…Four studies were from the United States [11,12,16,18], five studies were from Europe [10,[13][14][15]20], one study was from Asia [17], and one study was from multiple continents [19]. Furthermore, five studies were prospective studies [11,16,17,19,20], two studies were prospective randomized trials [11,19], and six studies were retrospective studies [10,[12][13][14][15]18]. In addition, four studies were multicenter trials [15,16,18,19].…”

Intrahepatic Stone in Post Liver Transplanted Patient

“…The challenge is the diagnosis of the indeterminate biliary stricture and the management of difficult bile stones endoscopically. The recent standard of care for the evaluation of the biliary stones is seen on MRCP, CT, or ultrasound beginning with ERCP, this technique utilizes fluoroscopy for the creation of 2D images for the localization and characterization of the bile duct pathology extent [5], [6].…”

The Expansion of Cholangioscopy: Established and Investigational Uses of SpyGlass in Biliary and Pancreatic Disorders

“…Recent studies have shown the benefit of using SOC in patients with both difficult and missed bile duct stones ( Figure 1). Stones can be classified as difficult when they are larger in size (>15 mm), impacted, located in a difficult locations such as near strictures, or if there are multiple stones present [9]. Various locations in the bile duct network have also been described where stones may be hidden or missed from detection using magnetic resonance cholangiopancreatography (MRCP) and ERCP [10].…”