Skip to main content

Advertisement

SpringerLink
Log in

Percutaneous transhepatic cholangioscopy for benign and malignant biliary disease using a novel short single-operator cholangioscope

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

The length of conventional single-use cholangioscopes poses a challenge for percutaneous or laparoscopic approaches for direct visualization of the biliary tract. The aim of this retrospective observational clinical study was to assess the use of a dedicated percutaneous short single-operator cholangioscope (PSSOC) for diagnosis and treatment of benign or malignant biliary diseases.

Methods

Retrospective analysis of a prospectively maintained database including all consecutive patients undergoing percutaneous transhepatic cholangioscopy with the PSSOC between 06/2021 and 01/2023.

Results

Forty patients were included (22F/18 M, age 58.7 ± 16.7 years). The diagnostic and therapeutic management plan was based on procedural findings. Indications were bile duct obstruction associated with complex anatomy (n = 13), choledocholithiasis (n = 11), suspected malignant stenosis of the biliary tract (n = 11), biliary stent placement (n = 2) and removal (n = 1), and failed endoscopic retrograde cholangiopancreatography (n = 2). The cholangioscopies were diagnostic (n = 5), therapeutic (n = 20) or both simultaneously (n = 15). The most frequent procedures were electrohydraulic lithotripsy (n = 25) and biopsy sampling (n = 12). Complications occurred in 7 cases (17.5%), including cholangitis (n = 4, B2), pleural perforation (n = 1, B2), portal bleeding (n = 1, B3), and Tako-Tsubo syndrome (n = 1, B3), classified according to the Society of Interventional Radiology classification. Intraprocedural visual diagnosis was confirmed by the histopathologic result in 11/12 patients in which biopsies were performed (91.7%). PSSOC was relevant to avoid surgery in 2 patients (5%) with indeterminate strictures, allowing to rule out malignancy and treat the lithiasis.

Conclusions

Direct visualization of the biliary tract enabled targeted biopsies for histopathological diagnosis. The visual and histopathological diagnoses were concordant in all but one case. Percutaneous cholangioscopy with a dedicated PSSOC allows to optimize identification and treatment of complex biliary disease including biliary lithiasis while assessing bile duct patency. The clinical use of the novel PSSOC system was safe and effective and could prevent surgical exploration in select patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Ahmed S, Schlachter TR, Hong K (2015) Percutaneous transhepatic cholangioscopy. Tech Vasc Interv Radiol 18:201–209. https://doi.org/10.1053/j.tvir.2015.07.003

    Article  PubMed  Google Scholar 

  2. Seo N, Kim DY, Choi J-Y (2017) Cross-sectional imaging of intrahepatic cholangiocarcinoma: development, growth, spread, and prognosis. Am J Roentgenol 209:W64–W75. https://doi.org/10.2214/AJR.16.16923

    Article  Google Scholar 

  3. Shin DW, Moon S-H, Kim JH (2023) Diagnosis of cholangiocarcinoma. Diagnostics 13:233. https://doi.org/10.3390/diagnostics13020233

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Lee YS (2022) Could the “SpyGlass direct visualization” system open new horizons for treating biliary tract diseases as a percutaneous cholangioscopy? Gut Liver 16:1–2. https://doi.org/10.5009/gnl210574

    Article  PubMed  PubMed Central  Google Scholar 

  5. Chon HK, Choi KH, Seo SH, Kim TH (2022) Efficacy and safety of percutaneous transhepatic cholangioscopy with the spyglass DS direct visualization system in patients with surgically altered anatomy: a pilot study. Gut Liver 16:111–117. https://doi.org/10.5009/gnl210028

    Article  PubMed  Google Scholar 

  6. Takada T, Kobayashi S, Yamada A, Uchida Y, Hayashi N (1974) A new technique for the diagnosis and therapy of cholangitic hepatic abscesses; percutaneous transhepatic cholangial drainage (auther’s transl). Nihon Shokakibyo Gakkai Zasshi 71:657–665

    CAS  PubMed  Google Scholar 

  7. Kahaleh M (2012) Spyglass direct visualization system. Clin Endosc 45:316–318. https://doi.org/10.5946/ce.2012.45.3.316

    Article  PubMed  PubMed Central  Google Scholar 

  8. Yodice M, Choma J, Tadros M (2020) The expansion of cholangioscopy: established and investigational uses of SpyGlass in biliary and pancreatic disorders. Diagn Basel Switz 10:132. https://doi.org/10.3390/diagnostics10030132

    Article  CAS  Google Scholar 

  9. Chen YK, Parsi MA, Binmoeller KF, Hawes RH, Pleskow DK, Slivka A, Haluszka O, Petersen BT, Sherman S, Devière J, Meisner S, Stevens PD, Costamagna G, Ponchon T, Peetermans JA, Neuhaus H (2011) Single-operator cholangioscopy in patients requiring evaluation of bile duct disease or therapy of biliary stones (with videos). Gastrointest Endosc 74:805–814. https://doi.org/10.1016/j.gie.2011.04.016

    Article  PubMed  Google Scholar 

  10. Council for International Organizations of Medical Sciences (CIOMS) (2017) Pautas éticas internacionales para la investigación relacionada con la salud con seres humanos. https://cioms.ch/wp-content/uploads/2018/01/CIOMS-EthicalGuideline_SP_WEB.pdf

  11. Seo DW, Lee SK, Yoo KS, Kang GH, Kim MH, Suh DJ, Min YI (2000) Cholangioscopic findings in bile duct tumors. Gastrointest Endosc 52:630–634. https://doi.org/10.1067/mge.2000.108667

    Article  CAS  PubMed  Google Scholar 

  12. Sun X, Zhou Z, Tian J, Wang Z, Huang Q, Fan K, Mao Y, Sun G, Yang Y (2015) Is single-operator peroral cholangioscopy a useful tool for the diagnosis of indeterminate biliary lesion? A systematic review and meta-analysis. Gastrointest Endosc 82:79–87. https://doi.org/10.1016/j.gie.2014.12.021

    Article  PubMed  Google Scholar 

  13. Navaneethan U, Hasan MK, Lourdusamy V, Njei B, Varadarajulu S, Hawes RH (2015) Single-operator cholangioscopy and targeted biopsies in the diagnosis of indeterminate biliary strictures: a systematic review. Gastrointest Endosc 82:608–614.e2. https://doi.org/10.1016/j.gie.2015.04.030

    Article  PubMed  PubMed Central  Google Scholar 

  14. Pereira P, Peixoto A, Andrade P, Macedo G (2017) Peroral cholangiopancreatoscopy with the SpyGlass® system: what do we know 10 years later. J Gastrointest Liver Dis 26:165–170. https://doi.org/10.15403/jgld.2014.1121.262.cho

    Article  Google Scholar 

  15. Costa M, Canena J, Mascarenhas-Lemos L, Loureiro R, Silva M, Carvalho D, Capela T, Russo P, Ramos G, Mateus-Dias A, Ferraz-Oliveira M, Veiga PM, Coimbra J (2018) Outcomes of different methods for analysis of biliary brush cytology and of factors associated with positive diagnosis in an age-dependent retrospective review. GE Port J Gastroenterol 26:5–13. https://doi.org/10.1159/000487153

    Article  PubMed  PubMed Central  Google Scholar 

  16. Archibugi L, Mariani A, Ciambriello B, Petrone MC, Rossi G, Testoni SGG, Carlucci M, Aldrighetti L, Falconi M, Balzano G, Doglioni C, Capurso G, Arcidiacono PG (2021) High sensitivity of ROSE-supported ERCP-guided brushing for biliary strictures. Endosc Int Open 9:E363–E370. https://doi.org/10.1055/a-1322-2638

    Article  PubMed  PubMed Central  Google Scholar 

  17. Chandrasekar VT, Faigel D (2021) Diagnosis and treatment of biliary malignancies: biopsy, cytology, cholangioscopy and stenting. Mini-invasive Surg 5:33. https://misjournal.net/article/view/4136. Accessed 16 Jun 2023

  18. Chen W-M, Wei K-L, Chen Y-S, Chang P-J, Tung S-Y, Chang T-S, Huang H-C, Shen C-H, Hsieh Y-Y, Wu C-S (2016) Transpapillary biliary biopsy for malignant biliary strictures: comparison between cholangiocarcinoma and pancreatic cancer. World J Surg Oncol 14:140. https://doi.org/10.1186/s12957-016-0883-8

    Article  PubMed  PubMed Central  Google Scholar 

  19. Navaneethan U, Njei B, Lourdusamy V, Konjeti R, Vargo JJ, Parsi MA (2015) Comparative effectiveness of biliary brush cytology and intraductal biopsy for detection of malignant biliary strictures: a systematic review and meta-analysis. Gastrointest Endosc 81:168–176. https://doi.org/10.1016/j.gie.2014.09.017

    Article  PubMed  Google Scholar 

  20. Wakai T, Shirai Y, Sakata J, Maruyama T, Ohashi T, Korira PV, Ajioka Y, Hatakeyama K (2012) Clinicopathological features of benign biliary strictures masquerading as biliary malignancy. Am Surg 78:1388–1391

    Article  PubMed  Google Scholar 

  21. Al Lehibi A, Aljahdali E, Al Balkhi A, Almasoudi T, Al Ghamdi A, Al Sayari K, Al Khathlan A, Qutub A, AlEid A, Ahmad S, Al Otaibi N, Al Mtawa A (2020) The utility of digital cholangioscopy (SpyGlass DS) in biliary and pancreatic diseases: a clinical feasibility study at two tertiary care centers in Saudi Arabia (with videos). Arab J Gastroenterol 21:49–53. https://doi.org/10.1016/j.ajg.2019.12.003

    Article  PubMed  Google Scholar 

  22. Angsuwatcharakon P, Rerknimitr R (2021) Cracking difficult biliary stones. Clin Endosc 54:660–668. https://doi.org/10.5946/ce.2020.256-IDEN

    Article  PubMed  PubMed Central  Google Scholar 

  23. Komanduri S, Thosani N, Dayyeh BKA, Aslanian HR, Enestvedt BK, Manfredi M, Maple JT, Navaneethan U, Pannala R, Parsi MA, Smith ZL, Sullivan SA, Banerjee S (2016) Cholangiopancreatoscopy. Gastrointest Endosc 84:209–221. https://doi.org/10.1016/j.gie.2016.03.013

    Article  PubMed  Google Scholar 

  24. Kim HJ, Kim JS, Joo MK, Lee BJ, Kim JH, Yeon JE, Park J-J, Byun KS, Bak Y-T (2015) Hepatolithiasis and intrahepatic cholangiocarcinoma: a review. World J Gastroenterol 21:13418–13431. https://doi.org/10.3748/wjg.v21.i48.13418

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Sofi AA, Khan MA, Das A, Sachdev M, Khuder S, Nawras A, Lee W (2018) Radiofrequency ablation combined with biliary stent placement versus stent placement alone for malignant biliary strictures: a systematic review and meta-analysis. Gastrointest Endosc 87:944–951.e1. https://doi.org/10.1016/j.gie.2017.10.029

    Article  PubMed  Google Scholar 

  26. Gerges C, Vázquez AG, Tringali A, Verde JM, Dertmann T, Houghton E, Cina A, Beyna T, Begnis FS, Pizzicannella M, Palermo M, Perretta S, Costamagna G, Marescaux J, Neuhaus H, Boškoski I, Giménez ME (2021) Percutaneous transhepatic cholangioscopy using a single-operator cholangioscope (pSOC), a retrospective, observational, multicenter study. Surg Endosc 35:6724–6730. https://doi.org/10.1007/s00464-020-08176-1

    Article  PubMed  Google Scholar 

  27. Lanza D, Casty A, Schlosser SH (2022) Endobiliary radiofrequency ablation for malignant biliary obstruction over 32-month follow-up. Gastrointest Tumors 9:12–18. https://doi.org/10.1159/000522363

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Yang J, Wang J, Zhou H, Zhou Y, Wang Y, Jin H, Lou Q, Zhang X (2018) Efficacy and safety of endoscopic radiofrequency ablation for unresectable extrahepatic cholangiocarcinoma: a randomized trial. Endoscopy 50:751–760. https://doi.org/10.1055/s-0043-124870

    Article  PubMed  Google Scholar 

  29. Sum Foong K, Lee A, Kudakachira S, Ramberan H (2016) Hemobilia from biliary angiodysplasia diagnosed with cholangioscopy. ACG Case Rep J 3:e132. https://doi.org/10.14309/crj.2016.105

    Article  Google Scholar 

  30. Turowski F, Hügle U, Dormann A, Bechtler M, Jakobs R, Gottschalk U, Nötzel E, Hartmann D, Lorenz A, Kolligs F, Veltzke-Schlieker W, Adler A, Becker O, Wiedenmann B, Bürgel N, Tröger 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 32:3981–3988. https://doi.org/10.1007/s00464-018-6141-0

    Article  PubMed  Google Scholar 

  31. Bokemeyer A, Müller F, Niesert H, Brückner M, Bettenworth D, Nowacki T, Beyna T, Ullerich H, Lenze F (2019) Percutaneous-transhepatic-endoscopic rendezvous procedures are effective and safe in patients with refractory bile duct obstruction. United Eur Gastroenterol J 7:397–404. https://doi.org/10.1177/2050640619825949

    Article  Google Scholar 

  32. 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 38:709–721. https://doi.org/10.1007/s00270-014-0992-0

    Article  CAS  Google Scholar 

  33. Inamdar S, Slattery E, Bhalla R, Sejpal DV, Trindade AJ (2016) Comparison of adverse events for endoscopic vs percutaneous biliary drainage in the treatment of malignant biliary tract obstruction in an inpatient national cohort. JAMA Oncol 2:112–117. https://doi.org/10.1001/jamaoncol.2015.3670

    Article  PubMed  Google Scholar 

  34. Deprez PH, Garces Duran R, Moreels T, Furneri G, Demma F, Verbeke L, Van der Merwe SW, Laleman W (2018) The economic impact of using single-operator cholangioscopy for the treatment of difficult bile duct stones and diagnosis of indeterminate bile duct strictures. Endoscopy 50:109–118. https://doi.org/10.1055/s-0043-121268

    Article  PubMed  Google Scholar 

Download references

Funding

This work was supported by French state funds managed within the “Plan Investissements d’Avenir” and by the ANR (reference ANR-10-IAHU-02).

Author information

Authors and Affiliations

  1. DAICIM Foundation (Training, Research and Clinical Activity in Minimally Invasive Surgery), Buenos Aires, Argentina

    A. K. Uribe Rivera, E. Houghton, F. Rodríguez, P. Acquafresca, M. Palermo & M. E. Giménez

  2. IHU-Strasbourg, Institute of Image-Guided Surgery, 1, Place de l’Hôpital, 67000, Strasbourg, France

    A. K. Uribe Rivera, B. Seeliger & M. E. Giménez

  3. IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France

    B. Seeliger & M. E. Giménez

  4. Department of Visceral and Digestive Surgery, Nouvel Hôpital Civil, University Hospitals of Strasbourg, Strasbourg, France

    B. Seeliger

  5. Dr. Eduardo Liceaga, General Hospital, Mexico City, Mexico

    C. A. Saldivar

Authors
  1. A. K. Uribe Rivera
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. B. Seeliger
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. A. Saldivar
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E. Houghton
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. F. Rodríguez
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. P. Acquafresca
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. M. Palermo
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. M. E. Giménez
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. K. Uribe Rivera.

Ethics declarations

Disclosures

C. A. Saldivar and M. E. Giménez are Boston Scientific consultants. A. K. Uribe Rivera, B. Seeliger, E. Houghton, F. Rodríguez, P. Acquafresca, and M. Palermo have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This work was presented at the 31st international EAES congress in Rome, Italy, June 20–23, 2023.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Uribe Rivera, A.K., Seeliger, B., Saldivar, C.A. et al. Percutaneous transhepatic cholangioscopy for benign and malignant biliary disease using a novel short single-operator cholangioscope. Surg Endosc 37, 7774–7783 (2023). https://doi.org/10.1007/s00464-023-10337-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-023-10337-x

Keywords

Search

Navigation