Endoscopy 2019; 51(04): S230
DOI: 10.1055/s-0039-1681858
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DIGITAL, SINGLE-OPERATOR CHOLANGIOPANCREATOSCOPY IN THE DIAGNOSIS AND MANAGEMENT OF PANCREATOBILIARY DISORDERS: RESULTS FROM A SINGLE TERTIARY CENTER

Authors

  • R Hustak

    1   Gastroenterology Department, University Hospital Trnava, Trnava, Slovakia
    2   Department of Laboratory Medicine, Faculty of Health Sciences and Social Work, University of Trnava, Trnava, Slovakia

  • J Usak

    1   Gastroenterology Department, University Hospital Trnava, Trnava, Slovakia

  • F Zavada

    1   Gastroenterology Department, University Hospital Trnava, Trnava, Slovakia
    3   Hospital Pribram, Pribram, Czech Republic

  • J Martinek

    1   Gastroenterology Department, University Hospital Trnava, Trnava, Slovakia
    4   Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

A new digital cholangioscopy (SPY DS) provides higher-resolution imaging of the pancreatobiliary tract. The aims of our study were to assess:

  1. diagnostic yield of SPY DS visual diagnosis and biopsies in patients with undetermined biliary strictures;

  2. the efficacy of SPY DS directed treatment of difficult lithiasis and

  3. safety of SPY DS.

Methods:

Retrospective analysis of prospectively collected data.

Results:

Since May 2015, a total of 59 patients underwent 66 SPY DS (65 cholangioscopies and 1 pancreatoscopy); among them 37 (56%) were performed with diagnostic intents (with biopsies in 29/33), and 29 (44%) in 21 patients with therapeutic intents (1x pancreaticolithiasis). The most frequent indication of SPY DS was undetermined stenosis (n = 33). Reliable views of a target lesion were obtained in all patients. The diagnostic accuracy for visual diagnosis of a malignant lesion reached 97% (CI 84.7 – 99.9). The mean number of biopsies obtained per patient was 3 (range 1 – 13) and the specimen was adequate for histopathological analysis in 93.1% of patients. The diagnostic accuracy of directed biopsies was 92.6% (75.7 – 99.1). Of 17 patients with difficult choledocho/cystico/hepatico lithiasis underwent laser lithotrypsi, a complete clearance was achieved in one session in 12 and in two sessions in further 4 patients, respectively, and the overall success rate was 94%. In one patient, a recurrence of hepaticolitiasis occurred after 1 year. A total of 13 patients (19.6%) experienced an adverse event, cholangitis being the most frequent in 6 (9.1%), followed by mild to moderate pancreatitis in 5 (7.6%) patients.

Conclusions:

  1. SPY DS provides a high diagnostic yield in patients with undetermined biliary stenosis;

  2. SPY DS directed biopsies had a high diagnostic accuracy but do not always provide sufficient specimen;

  3. SPY DS guided stone lithotripsy was effective in majority of patients and

  4. The most frequent complication was cholangitis in 9% of patients.