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Diagnostic and therapeutic single-operator cholangiopancreatoscopy with SpyGlassDS™: results of a multicenter retrospective cohort study

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Abstract

Background and aims

The aim of the study was to evaluate the usefulness and diagnostic and therapeutic outcome of the single-operator cholangiopancreatoscopy (SOC) with SpyGlassDS™.

Methods

In a retrospective multicenter study between November 2015 and January 2017, SpyGlassDS™ procedures were analyzed in participating centers. Indications, accuracy of SOC-guided biopsies, management of large bile duct stones, and complications were analyzed. Follow-up was 4 months.

Results

Two hundred and six patients out of 250 examinations were evaluated. Indications were biliary stones (n = 132), bile duct stenosis (n = 93), stones and stenosis combined (n = 24), and bile duct leakage (n = 1). Of the 117 cases which were suspicious of malignancy, in 99 cases the lesion could be stratified into benign (n = 55) or malignant (n = 44) indicating a sensitivity of 95.5% and a specificity of 94.5% for the indication tumor. SOC-guided biopsies revealed a sensitivity of 57.7% with a specificity of 100%. In 107 examinations, biliary stones were visualized and could be completely removed in 91.1% with a need of three procedures (range 1–6) to achieve final stone clearance. In 75 cases, lithotripsy was performed and was successful in 71 cases (95%). Four out of 45 patients (8.9%) underwent cholecystectomy with surgical bile duct revision as a final therapy. Adverse Event (AE) occurred in 33/250 patients (13.2%) and Serious Adverse Event (SAE) occurred in 1/250 patients (0.4%). Cholangitis was 1% (n = 102) after peri-interventional administration of antibiotics and 12.8% (n = 148) without antibiotic prophylaxis (p < 0.001).

Conclusions

SOC with SpyGlassDS™ became a new standard for the diagnosis of indefinite biliary lesions and therapy of large bile duct stones. The diagnostic yield of SOC-guided biopsies facilitated a definite diagnosis in most cases and should be improved by standardized biopsy protocols. SOC-guided interventions allowed removal of large biliary stones by SOC-guided lithotripsy. The complication rate of 13.2% can be considerably reduced by use of a single-shot antibiotic treatment.

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Author notes

  1. Felicia Turowski and Ulrich Hügle have contributed equally to this work.

Authors and Affiliations

  1. Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie und Rheumatologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany

    Felicia Turowski, Nataly Bürgel, Hanno Tröger, Michael Schumann, Severin Daum, Britta Siegmund & Christian Bojarski

  2. Krankenhaus Holweide, Medizinische Klinik, Kliniken der Stadt Köln, 51058, Cologne, Germany

    Ulrich Hügle & Arno Dormann

  3. Medizinische Klinik C, Klinikum Ludwigshafen, Bremser Str. 79, 67063, Ludwigshafen, Germany

    Matthias Bechtler & Ralf Jakobs

  4. Klinik für Innere Medizin I, Dietrich Bonhoeffer Klinikum, Salvador-Allende-Str. 30, 17036, Neubrandenburg, Germany

    Uwe Gottschalk

  5. Innere Medizin I: Schwerpunkt Gastroenterologie, Sana Klinikum Lichtenberg, Fanningerstr. 32, 10365, Berlin, Germany

    Ellen Nötzel & Dirk Hartmann

  6. Klinik für Allgemeine Innere Medizin und Gastroenterologie, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany

    Albrecht Lorenz & Frank Kolligs

  7. Medizinische Klinik mit Schwerpunkt Gastroenterologie und Hepatologie, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany

    Wilfried Veltzke-Schlieker, Andreas Adler, Olaf Becker & Bertram Wiedenmann

Authors
  1. Felicia Turowski
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  2. Ulrich Hügle
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  3. Arno Dormann
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  4. Matthias Bechtler
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  5. Ralf Jakobs
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  6. Uwe Gottschalk
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  7. Ellen Nötzel
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  8. Dirk Hartmann
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  9. Albrecht Lorenz
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  10. Frank Kolligs
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  11. Wilfried Veltzke-Schlieker
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  12. Andreas Adler
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  13. Olaf Becker
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  14. Bertram Wiedenmann
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  15. Nataly Bürgel
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  16. Hanno Tröger
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  17. Michael Schumann
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  18. Severin Daum
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  19. Britta Siegmund
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  20. Christian Bojarski
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Corresponding author

Correspondence to Christian Bojarski.

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Disclosure

Felicia Turowski and Drs. Hügle, Bechtler, Gottschalk, Nötzel, Hartmann, Lorenz, Veltzke-Schlieker, Adler, Becker, Bürgel, Tröger, Schumann, Daum, and Bojarski as well as Prof. Dormann, Prof. Jakobs, Prof. Kolligs, Prof. Wiedenmann, and Prof. Siegmund have no conflicts of interest or financial ties to disclose.

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Turowski, F., Hügle, U., Dormann, A. et al. Diagnostic and therapeutic single-operator cholangiopancreatoscopy with SpyGlassDS™: results of a multicenter retrospective cohort study. Surg Endosc 32, 3981–3988 (2018). https://doi.org/10.1007/s00464-018-6141-0

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  • DOI: https://doi.org/10.1007/s00464-018-6141-0

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