USEFULNESS OF DEDICATED FORCEPS FOR DIGITAL SINGLE-OPERATOR CHOLANGIOSCOPY FOR THE TREATMENT OF INFLAMMATORY BILIARY STRICTURE

Endoscopic treatment of biliary strictures is challenging; moreover, if stenosis is almost complete, dilation can fail for inability to pass over a guidewire dilation devices or stent [1].

Cholangioscopy can be useful in order to overcome these limits, thanks to direct visualization of the stricture.

A 52 year-old-woman affected by antiphospholipid syndrome underwent endoscopic retrograde cholangiography for recurrent cholangitis due to hepatolithiasis for secondary hemolytic anemia. For inability to pass the guidewire over the stenosis, digital single-operator cholangioscopy (SpyGlass DS, Boston Scientific) was performed for selectively placement of guidewire.

An intrahepatic right biliary stricture was observed, with a residual lumen of about 2 mm. A fibrotic ring allowed the guidewire pass only (Dreamwire 0.035, Boston Scientifc), but not devices for dilation, i.e. balloon or Soehendra dilators. So, it was excised with dedicated forceps (Spybite, Boston Scientific), allowing subsequent pneumatic dilation and spontaneous spillage of multiple micro-gallstones [video]. Plastic stent was placed for 2 months, obtaining stricture's resolution at cholangioscopic control. Histological biopsies confirmed the benign nature and elective cholecystectomy was performed.

The patient remained in good clinical condition with no more cholangitis episodes.

In conclusion, dedicated cholangioscopic forceps can be a useful tool to cutting out fibrotic ring in biliary strictures, allowing subsequent endoscopic treatment, avoiding major surgery (in this case right hepatectomy), especially in high-risk patients.

Reference:

[1] Bokemayer A., Gross D., Bruckner M. et al. Digital single-operator cholangioscopy: a useful tool for selective guidewire placement across complex biliary strictures. Surg End 2018 Jul 13. doi:10.1007/s00464 – 018 – 6334 – 6.