Role of digital single-operator cholangioscopy in the diagnosis and treatment of biliary disorders

Abstract

Due to the need for improvement in the diagnosis and minimally invasive therapy of the bile duct disorders new technologies for cholangioscopy have been recently developed. Per-oral cholangioscopy has become an important diagnostic and therapeutic tool leading to avoidance of aggressive and unnecessary surgery in many clinical scenarios. This paper focuses on the newly developed SpyGlass DS technology, its advantages, and the technique of single-operator cholangioscopy (SOC), biliary indications and possible adverse events. We also review the available literature; discuss the limitations and future expectations. Digital SOC (D-SOC) is a useful technique, which provides endoscopic imaging of the biliary tree, optical diagnosis, biopsy under direct vision and therapeutic interventions. The implementations are diagnostic and therapeutic. Diagnostic indications are indeterminate biliary strictures, unclear filling defects, staging of cholangiocarcinoma, staging of ampullary tumors (extension into the common bile duct), unclear bile duct dilation, exploring cystic lesions of the biliary tree, unexplained hemobilia, posttransplant biliary complications. Therapeutic indications are lithotripsy of difficult stones, retrieval of migrated stents, foreign body removal, guide wire placement, transpapillary gallbladder drainage and endoscopic tumor ablative therapy. Most studied and established indications are the diagnosis of indeterminate biliary stricture and intraductal lithotripsy of difficult stones. The adverse events are not different and more common compared to those of Endoscopic retrograde cholangiopancreatography (ERCP) alone. D-SOC is a safe and effective procedure, adjunct to the standard ERCP and the newly available digital technology overcomes many of the limitations of the previous generations of cholangioscopes.

Efficacy and safety of peroral cholangioscopy with intraductal lithotripsy for difficult biliary stones: a systematic review and meta-analysis

“…Cholangioscopy allows for: improved maneuverability to directly locate, visualize, and treat intrahepatic and cystic duct stones; unprecedented direct visualization to reduce duct injury; and assessment for residual stones after stone extraction to confirm ductal clearance [26 -28]. The limitations of cholangioscopy include: significant cost; the need for expertise; the need for sufficient papillary and bile duct diameters to allow insertion of the cholangioscope; longer duration of procedure compared with other strategies; and the high success rates of traditional ERCP [25,29].…”

Per-oral pancreatoscopy with intraductal lithotripsy for difficult pancreatic duct stones: a systematic review and meta-analysis

“…In addition to use as an adjunctive therapy, pancreatoscopy allows for improved maneuverability to directly locate, visualize, and treat pancreatic duct stones; direct visualization to reduce duct injury, confirm ductal clearance, plus assess for residual stones after stone extraction; and may even detect pancreatic duct stones previously missed on high-resolution imaging such as magnetic resonance 37 38 39 . Limitations or disadvantages of per-oral pancreatoscopy include significant cost, the need for expertise or familiarity with the device to achieve cannulation and access to the pancreatic duct, need for sufficient diameter of the pancreatic duct due to diameter of the pancreatoscope, long duration of procedure compared to other strategies, and moderate success rates of conventional strategies 40 41 .…”

SpyGlass application for duodenoscope working channel inspection: Impact on the microbiological surveillance

“…The Spyglass visualization system is designed to interface with computer software and to record both still and video images[ 10 , 15 ]. This system has been widely applied to treat biliopancreatic diseases[ 23 ]. Currently, the available borescopes have short lengths of 95-110 cm[ 10 ]; therefore, borescopes do not allow for a one-step complete inspection of the 140-cm working channel of a duodenoscope.…”