Percutaneous transhepatic cholangioscopy for indeterminate biliary strictures using the SpyGlass system: a case series

Abstract

Peroral cholangioscopy is useful in differentiating benign from malignant biliary strictures. However, when conventional biliary access via endoscopic retrograde cholangiopancreatography (ERCP) fails, percutaneous transhepatic cholangioscopy (PTCS) via the SpyGlass cholangioscopy system can be used to achieve a diagnosis. Four patients with biliary strictures in whom conventional ERCP was not possible and percutaneous brushings were either nondiagnostic or unsatisfactory were investigated with PTCS. The technique of PTCS involves insertion of the SpyGlass cholangioscope through a percutaneous transhepatic sheath, placed just prior to the procedure, to visualize the stricture and obtain biopsies with the SpyBite forceps. On the basis of our early observations, we conclude that PTCS using the SpyGlass cholangioscopy system for the assessment of biliary strictures is feasible, safe, and provides high diagnostic accuracy.

Review article: Asia‐Pacific consensus recommendations on endoscopic tissue acquisition for biliary strictures

“…The term “indeterminate biliary strictures” refers to the situation when imaging studies and standard transpapillary tissue sampling are nondiagnostic for suspected malignant biliary strictures . Patients with indeterminate biliary strictures may require a multidisciplinary diagnostic approach and may need repeating endoscopic evaluation with various tissue diagnostic technologies (eg EUS‐guided sampling, cholangioscopy‐guided biopsy and molecular analysis) before reaching a conclusive diagnosis . In a prospective, single centre, small‐scale study including 40 patients with indeterminate biliary strictures, EUS‐guided fine needle aspiration provided a histological diagnosis in 58% (23/30) of patients who underwent the procedure.…”

Percutaneous Transhepatic Cholangioscopy and Lithotripsy for Intrahepatic Biliary Stones and Sclerosing Cholangitis Secondary to Kasai Procedure for Biliary Atresia: A Case Report

“…Both the use of antibiotics for intestinal decontamination and that of PTC or surgical revision for mechanical relief of biliary obstruction have been previously reported for this condition [6]. Additionally, cases of endoscopic treatment with the use of balloon-assisted ERCP have also been reported [5,6]. However, in those cases in which patients are unsuitable for surgery, or those in which balloon-assisted ERCP fails to establish bile cannulation, PTCS may be the optimal alternative both as diagnostic tool and as therapeutic solution, as described in a few rare cases of PTCS-assisted lithotripsy [9].…”

“…Patients with secondary cholangitis often have poor outcomes, progression of portal hypertension and the need of early transplantation [7,8]. Both the use of antibiotics for intestinal decontamination and that of PTC or surgical revision for mechanical relief of biliary obstruction have been previously reported for this condition [6]. Additionally, cases of endoscopic treatment with the use of balloon-assisted ERCP have also been reported [5,6].…”

“…Recently, however, the introduction of percutaneous transhepatic cholangiopscopy (PTCS) has improved access to the biliary system in those cases in which a peroral endoscopic approach to the biliary system is difficult or impossible [4,5]. Multiple series using these procedures have demonstrated substantial improvements in mortality, but long-term complications remain a significant problem, with most patients developing cholangitis and liver failure requiring liver transplantation [6]. Here we report the use of PTCS in a patient with recurrent cholangitis, intrahepatic lithiasis and sclerosing cholangitis after a Kasai procedure.…”

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

“…We also utilized D-SOC via a percutaneous biliary sheath to perform EHL for stone fragmentation in a patient with altered anatomy due to prior Roux-en-Y gastric bypass surgery. 17…”