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Digital single-operator cholangioscopy: a useful tool for selective guidewire placements across complex biliary strictures

  • Arne Bokemeyer
  • Dina Gross
  • Markus Brückner
  • Tobias Nowacki
  • Dominik Bettenworth
  • Hartmut Schmidt
  • Hauke Heinzow
  • Iyad Kabar
  • Hansjoerg Ullerich
  • Frank Lenze
Article
  • 71 Downloads

Abstract

Background

Treatment of biliary strictures is challenging. Digital single-operator cholangioscopes (SOCs) equipped with an improved imaging quality, were recently introduced and may be useful for selective guidewire placement in difficult biliary strictures.

Methods

A total of 167 digital SOC procedures performed between 2015 and 2018 were retrospectively analyzed for successful guidewire placements across biliary strictures. Only cases with previous failed conventional guidewire placement approaches were included.

Results

In total, 30 examinations with a digital SOC-assisted guidewire placement across biliary strictures, performed in 23 patients, were identified. In 52% of all patients, the stricture was benign with post-liver-transplant strictures (75%) as the most frequent finding; in 48% of all patients the stricture was malignant with cholangiocellular carcinoma as the most frequent type (64%). Guidewire placement was successful in 21 of 30 procedures (70%). According to a subgroup analysis, digital SOC-assisted guidewire placements were significantly more successful in patients with benign strictures than those in patients with malignant strictures (88.2% vs. 46.2%; p = 0.02). Furthermore, the technical success rate tended to be increased in cases of initial examinations (78.3%) than in patients with repeated examinations (42.9%; p = 0.15). Adverse events, such as post-interventional pancreatitis or cholangitis as well as severe bleeding occurred in 16.7% of all examinations.

Conclusions

Digital SOC-assisted guidewire placements have high technical success rates, especially in benign biliary strictures. This technique can help to avoid more invasive procedures such as percutaneous transhepatic or endoscopic ultrasound-guided biliary drainage.

Keywords

Biliary strictures Cholangioscopy Digital single-operator cholangioscopy Guidewire placement and SpyGlass DS 

Notes

Compliance with ethical standards

Disclosures

Dina Gross and Drs. Arne Bokemeyer, Tobias Nowacki, Markus Brückner, Hauke Heinzow, Iyad Kabar, Hansjoerg Ullerich and Frank Lenze as well as Prof. Dr. Dominik Bettenworth and Prof. Dr. Hartmut Schmidt have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Paranandi B, Oppong KW (2017) Biliary strictures: endoscopic assessment and management. Frontline Gastroenterol 8(2):133–137.  https://doi.org/10.1136/flgastro-2016-100773 CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    de Groen PC, Gores GJ, LaRusso NF, Gunderson LL, Nagorney DM (1999) Biliary tract cancers. N Engl J Med 341(18):1368–1378.  https://doi.org/10.1056/NEJM199910283411807 CrossRefPubMedGoogle Scholar
  3. 3.
    Aparicio D, Otoch JP, Montero EFS, Khan MA, Artifon ELA (2017) Endoscopic approach for management of biliary strictures in liver transplant recipients: a systematic review and meta-analysis. United Eur Gastroenterol J 5(6):827–845.  https://doi.org/10.1177/2050640616681909 CrossRefGoogle Scholar
  4. 4.
    Hsieh TH, Mekeel KL, Crowell MD, Nguyen CC, Das A, Aqel BA, Carey EJ, Byrne TJ, Vargas HE, Douglas DD, Mulligan DC, Harrison ME (2013) Endoscopic treatment of anastomotic biliary strictures after living donor liver transplantation: outcomes after maximal stent therapy. Gastrointest Endosc 77(1):47–54.  https://doi.org/10.1016/j.gie.2012.08.034 CrossRefPubMedGoogle Scholar
  5. 5.
    Chok KS, Chan SC, Cheung TT, Sharr WW, Chan AC, Fan ST, Lo CM (2014) A retrospective study on risk factors associated with failed endoscopic treatment of biliary anastomotic stricture after right-lobe living donor liver transplantation with duct-to-duct anastomosis. Ann Surg 259(4):767–772.  https://doi.org/10.1097/SLA.0b013e318294d0ce CrossRefPubMedGoogle Scholar
  6. 6.
    Kim ES, Lee BJ, Won JY, Choi JY, Lee DK (2009) Percutaneous transhepatic biliary drainage may serve as a successful rescue procedure in failed cases of endoscopic therapy for a post-living donor liver transplantation biliary stricture. Gastrointest Endosc 69(1):38–46.  https://doi.org/10.1016/j.gie.2008.03.1113 CrossRefPubMedGoogle Scholar
  7. 7.
    Lee YY, Gwak GY, Lee KH, Lee JK, Lee KT, Kwon CH, Joh JW, Lee SK (2011) Predictors of the feasibility of primary endoscopic management of biliary strictures after adult living donor liver transplantation. Liver Transplant 17(12):1467–1473.  https://doi.org/10.1002/lt.22432 CrossRefGoogle Scholar
  8. 8.
    Hisatsune H, Yazumi S, Egawa H, Asada M, Hasegawa K, Kodama Y, Okazaki K, Itoh K, Takakuwa H, Tanaka K, Chiba T (2003) Endoscopic management of biliary strictures after duct-to-duct biliary reconstruction in right-lobe living-donor liver transplantation. Transplantation 76(5):810–815.  https://doi.org/10.1097/01.TP.0000083224.00756.8F CrossRefPubMedGoogle Scholar
  9. 9.
    Wright H, Sharma S, Gurakar A, Sebastian A, Kohli V, Jabbour N (2008) Management of biliary stricture guided by the Spyglass Direct Visualization System in a liver transplant recipient: an innovative approach. Gastrointest Endosc 67(7):1201–1203.  https://doi.org/10.1016/j.gie.2007.10.055 CrossRefPubMedGoogle Scholar
  10. 10.
    Woo YS, Lee JK, Noh DH, Park JK, Lee KH, Lee KT (2016) SpyGlass cholangioscopy-assisted guidewire placement for post-LDLT biliary strictures: a case series. Surg Endosc 30(9):3897–3903.  https://doi.org/10.1007/s00464-015-4695-7 CrossRefPubMedGoogle Scholar
  11. 11.
  12. 12.
    Tringali A, Lemmers A, Meves V, Terheggen G, Pohl J, Manfredi G, Hafner M, Costamagna G, Deviere J, Neuhaus H, Caillol F, Giovannini M, Hassan C, Dumonceau JM (2015) Intraductal biliopancreatic imaging: European Society of Gastrointestinal Endoscopy (ESGE) technology review. Endoscopy 47(8):739–753.  https://doi.org/10.1055/s-0034-1392584 CrossRefPubMedGoogle Scholar
  13. 13.
    Chen YK, Pleskow DK (2007) SpyGlass single-operator peroral cholangiopancreatoscopy system for the diagnosis and therapy of bile-duct disorders: a clinical feasibility study (with video). Gastrointest Endosc 65(6):832–841.  https://doi.org/10.1016/j.gie.2007.01.025 CrossRefPubMedGoogle Scholar
  14. 14.
    Chen YK (2007) Preclinical characterization of the Spyglass peroral cholangiopancreatoscopy system for direct access, visualization, and biopsy. Gastrointest Endosc 65(2):303–311.  https://doi.org/10.1016/j.gie.2006.07.048 CrossRefPubMedGoogle Scholar
  15. 15.
    Pereira P, Peixoto A, Andrade P, Macedo G (2017) Peroral cholangiopancreatoscopy with the SpyGlass(R) system: what do we know 10 years later. J Gastrointest Liver Dis 26(2):165–170.  https://doi.org/10.15403/jgld.2014.1121.262.cho Google Scholar
  16. 16.
    Lenze F, Bokemeyer A, Gross D, Nowacki T, Bettenworth D, Ullerich H (2018) Safety, diagnostic accuracy and therapeutic efficacy of digital single-operator cholangioscopy. United Eur Gastroenterol J.  https://doi.org/10.1177/2050640618764943 Google Scholar
  17. 17.
    Imanishi M, Ogura T, Kurisu Y, Onda S, Takagi W, Okuda A, Miyano A, Amano M, Nishioka N, Masuda D, Higuchi K (2017) A feasibility study of digital single-operator cholangioscopy for diagnostic and therapeutic procedure (with videos). Medicine 96(15):e6619.  https://doi.org/10.1097/MD.0000000000006619 CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Ogura T, Imanishi M, Kurisu Y, Onda S, Sano T, Takagi W, Okuda A, Miyano A, Amano M, Nishioka N, Yamada T, Masuda D, Takenaka M, Kitano M, Higuchi K (2017) Prospective evaluation of digital single-operator cholangioscope for diagnostic and therapeutic procedures (with videos). Dig Endosc.  https://doi.org/10.1111/den.12878 Google Scholar
  19. 19.
    Husing-Kabar A, Heinzow HS, Schmidt HH, Stenger C, Gerth HU, Pohlen M, Tholking G, Wilms C, Kabar I (2017) Single-operator cholangioscopy for biliary complications in liver transplant recipients. World J Gastroenterol 23(22):4064–4071.  https://doi.org/10.3748/wjg.v23.i22.4064 CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Martins FP, Ferrari AP (2017) Cholangioscopy-assisted guidewire placement in post-liver transplant anastomotic biliary stricture: efficient and potentially also cost-effective. Endoscopy 49(11):E283–E284.  https://doi.org/10.1055/s-0043-117940 CrossRefPubMedGoogle Scholar
  21. 21.
    Hakuta R, Kogure H, Nakai Y, Takahara N, Mizuno S, Tada M, Koike K (2018) Successful guidewire placement across hilar malignant biliary stricture after deceased donor liver transplantation using new digital cholangioscopy. Endoscopy 50(3):E54–E56.  https://doi.org/10.1055/s-0043-123817 CrossRefPubMedGoogle Scholar
  22. 22.
    Loperfido S, Angelini G, Benedetti G, Chilovi F, Costan F, De Berardinis F, De Bernardin M, Ederle A, Fina P, Fratton A (1998) Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study. Gastrointest Endosc 48(1):1–10CrossRefPubMedGoogle Scholar
  23. 23.
    Baron TH, Petersen BT, Mergener K, Chak A, Cohen J, Deal SE, Hoffinan B, Jacobson BC, Petrini JL, Safdi MA, Faigel DO, Pike IM, Endoscopy AAToQi (2006) Quality indicators for endoscopic retrograde cholangiopancreatography. Am J Gastroenterol 101(4):892–897.  https://doi.org/10.1111/j.1572-0241.2006.00675.x CrossRefPubMedGoogle Scholar
  24. 24.
    Pezzullo JC (2018) 2-way Contingency Table Analysis. http://statpages.info/ctab2x2.html
  25. 25.
    Navaneethan U, Hasan MK, Kommaraju K, Zhu X, Hebert-Magee S, Hawes RH, Vargo JJ, Varadarajulu S, Parsi MA (2016) Digital, single-operator cholangiopancreatoscopy in the diagnosis and management of pancreatobiliary disorders: a multicenter clinical experience (with video). Gastrointest Endosc 84(4):649–655.  https://doi.org/10.1016/j.gie.2016.03.789 CrossRefPubMedGoogle Scholar
  26. 26.
    Turowski F, Hugle U, Dormann A, Bechtler M, Jakobs R, Gottschalk U, Notzel E, Hartmann D, Lorenz A, Kolligs F, Veltzke-Schlieker W, Adler A, Becker O, Wiedenmann B, Burgel N, Troger H, Schumann M, Daum S, Siegmund B, Bojarski C (2018) Diagnostic and therapeutic single-operator cholangiopancreatoscopy with SpyGlassDS: results of a multicenter retrospective cohort study. Surg Endosc.  https://doi.org/10.1007/s00464-018-6141-0 PubMedGoogle Scholar
  27. 27.
    Anderson CD, Pinson CW, Berlin J, Chari RS (2004) Diagnosis and treatment of cholangiocarcinoma. Oncol 9(1):43–57Google Scholar
  28. 28.
    Cai Y, Cheng N, Ye H, Li F, Song P, Tang W (2016) The current management of cholangiocarcinoma: a comparison of current guidelines. Biosci Trends 10(2):92–102.  https://doi.org/10.5582/bst.2016.01048 CrossRefPubMedGoogle Scholar
  29. 29.
    Dawwas MF, Oppong KW, Webster GJ (2016) Endoscopic assessment and management of biliary strictures. Frontline Gastroenterol 7(3):170–175.  https://doi.org/10.1136/flgastro-2015-100570 CrossRefPubMedGoogle Scholar
  30. 30.
    Neal CP, Thomasset SC, Bools D, Sutton CD, Garcea G, Mann CD, Rees Y, Newland C, Robinson RJ, Dennison AR, Berry DP (2010) Combined percutaneous-endoscopic stenting of malignant biliary obstruction: results from 106 consecutive procedures and identification of factors associated with adverse outcome. Surg Endosc 24(2):423–431.  https://doi.org/10.1007/s00464-009-0586-0 CrossRefPubMedGoogle Scholar
  31. 31.
    Li M, Bai M, Qi X, Li K, Yin Z, Wang J, Wu W, Zhen L, He C, Fan D, Zhang Z, Han G (2015) Percutaneous transhepatic biliary metal stent for malignant hilar obstruction: results and predictive factors for efficacy in 159 patients from a single center. Cardiovasc Interv Radiol 38(3):709–721.  https://doi.org/10.1007/s00270-014-0992-0 CrossRefGoogle Scholar
  32. 32.
    Chang JH, Lee I, Choi MG, Han SW (2016) Current diagnosis and treatment of benign biliary strictures after living donor liver transplantation. World J Gastroenterol 22(4):1593–1606.  https://doi.org/10.3748/wjg.v22.i4.1593 CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Tarantino I, Barresi L, Petridis I, Volpes R, Traina M, Gridelli B (2008) Endoscopic treatment of biliary complications after liver transplantation. World J Gastroenterol 14(26):4185–4189CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Shah JN, Ahmad NA, Shetty K, Kochman ML, Long WB, Brensinger CM, Pfau PR, Olthoff K, Markmann J, Shaked A, Reddy KR, Ginsberg GG (2004) Endoscopic management of biliary complications after adult living donor liver transplantation. Am J Gastroenterol 99(7):1291–1295.  https://doi.org/10.1111/j.1572-0241.2004.30775.x CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Arne Bokemeyer
    • 1
  • Dina Gross
    • 1
  • Markus Brückner
    • 1
  • Tobias Nowacki
    • 1
  • Dominik Bettenworth
    • 1
  • Hartmut Schmidt
    • 1
  • Hauke Heinzow
    • 1
  • Iyad Kabar
    • 1
  • Hansjoerg Ullerich
    • 1
  • Frank Lenze
    • 1
  1. 1.Department of Medicine B for Gastroenterology and HepatologyUniversity Hospital MuensterMuensterGermany

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