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Usefulness of the single-operator cholangioscopy system SpyGlass in biliary disease: a single-center prospective cohort study and aggregated review

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Abstract

Background and study aim

Indeterminate biliary strictures and difficult bile duct stones remain clinically arduous and challenging situations. We aimed to evaluate the utility of the single-operator cholangioscopy (SOC)-system SpyGlass in both conditions in a single-center biliopancreatic interventional unit and in perspective of available aggregated literature.

Methods

Usefulness of SOC was assessed for the above-mentioned indications by means of the combination of successful procedural completion, clinical success and incidence of procedure-related adverse events in our own prospective cohort from 3/2010 to 7/2014 and all available literature till 6/2015.

Results

Our single-center cohort constituted of 84 patients undergoing SpyGlass either for indeterminate strictures (n = 45) or difficult stones (n = 39). In addition, a comprehensive literature review yielded 851 patients (from 15 series) for either stenosis (n = 646, 75.9 %) and difficult stones (n = 205, 24.1 %). In our series, overall procedural success amounted to 85.7 % (with 88.9 % for stenosis or 82.1 % for stones) compared to 90.7, 91.5 and 88.3 % in overall literature, respectively. Sensitivity, specificity and accuracy for visual diagnosis in our cohort added up to 83.3, 82.9 and 82.9 % compared to 90.8, 90.9 and 90.8 % in the pooled analysis. Respective figures for SOC-directed biopsies totaled 85.7, 100 and 95.7 % in our cohort and 72.4, 100 and 84 % overall. Overall procedure-related complications varied between 9.4 and 21.4 %.

Conclusions

The SOC-platform SpyGlass can be considered useful in the context of indeterminate biliary strictures and difficult-to-remove biliary stones. In both, SpyGlass-assisted intervention is associated with high procedural success and alters clinical outcome compared to conventional approaches with an acceptable safety profile.

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References

  1. Erim T, Shiroky J, Pleskow DK (2013) Cholangioscopy: the biliary tree never looked so good! Curr Opin Gastroenterol 29:501–508

    Article  PubMed  Google Scholar 

  2. Cotton PB (2012) Endoscopic retrograde cholangiopancreaticography: maximizing benefits and minimizing risks. Gastrointest Endosc Clin N Am 22:587–599

    Article  PubMed  Google Scholar 

  3. Singh A, Gelrud A, Agarwal B (2015) Biliary strictures: diagnostic considerations and approach. Gastroenterol Rep (Oxf) 3:22–31. doi:10.1093/gastro/gou072

    Article  Google Scholar 

  4. Yasuda I, Itoi T (2013) Recent advances in endoscopic management of difficult bile duct stones. Dig Endosc 25:376–385

    Article  PubMed  Google Scholar 

  5. Chen YK, Pleskow DK (2007) SpyGlass single-operator peroral cholangiopancreaticogastroscopy system for the diagnosis and therapy of bile-duct disorders: a clinical feability study. Gastrointest Endosc 65:832–841

    Article  PubMed  Google Scholar 

  6. 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

    Article  PubMed  Google Scholar 

  7. Gerhards MF, Vos P, van Gulik TM, Rauws EA, Bosma A, Gouma DJ (2001) Incidence of benign lesions in patients resected for suspicious hilar obstruction. Br J Surg 88:48–51

    Article  CAS  PubMed  Google Scholar 

  8. Corvera CU, Blumgart LH, Darvishian F, Klimstra DS, DeMatteo R, Fong Y, D’Angelica M, Jarnagin WR (2005) Clinical and pathologic features of proximal biliary strictures masquerading as hilar cholangiocarcinoma. J Am Coll Surg 201:862–869

    Article  PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  10. Hj Kim, Choi HS, Park JH, Park DI, Cho YK, Sohn CI, Jeon WK, Kim BI, Choi SH (2007) Factors influencing the technical difficulty of endoscopic clearance of bile duct stones. Gastrointest Endosc 66:1154–1160

    Article  Google Scholar 

  11. McHenry L, Lehman G (2006) Difficult bile duct stones. Curr Treat Options Gastroenterol 9:123–132

    Article  PubMed  Google Scholar 

  12. Draganov PV, Lin T, Chauhan S, Wagh MS, Hou W, Forsmark CE (2011) Prospective evaluation of the clinical utility of ERCP-guided cholangiopancreaticoscopy with a new direct visualization system. Gastrointest Endosc 73:971–979

    Article  PubMed  Google Scholar 

  13. Ramchandani M, Reddy DN, Gupta R, Lakhtakia S, Tandan M, Darisetty S, Sekaran A, Rao GV (2011) Role of single-operator peroral cholangioscopy in the diagnosis of indeterminate biliary lesions: a single-center prospective study. Gastrointest Endosc 74:511–519

    Article  PubMed  Google Scholar 

  14. Siddiqui AA, Mehendiratta V, Jackson W, Loren DE, Kowalski TE, Eloubeidi MA (2012) Identification of cholangiocarcinoma by using the SpyGlass Spyscope system for peroral cholangioscopy and biopsy collection. Clin Gastroenterol Hepatol 10:466–471

    Article  PubMed  Google Scholar 

  15. Kalaitzakis E, Webster GJ, Oppong KW, Kallis Y, Vlavianos P, Huggett M, Dawwas MF, Lekhraju V, Hatfield A, Westaby D, Surgess R (2012) Diagnostic and therapeutic utility of single-operator peroral cholangioscopy for indeterminate biliary lesions and bile duct stones. Eur J Gastroenterol Hepatol 24:656–664

    Article  PubMed  Google Scholar 

  16. Manta R, Frazzoni M, Conigliaro R, Maccio L, Melotti G, Dabizzi E, Bertani H, Manno M, Castellani D, Villanacci V, Bassotti G (2013) SpyGlass single-operator peroral cholangioscopy in the evaluation of indeterminate biliary lesions: a single-center prospective, cohort study. Surg Endosc 27:1569–1572

    Article  PubMed  Google Scholar 

  17. Nguyen NQ, Schoemann MN, Ruszkiewicz A (2013) Clinical utility of EUS before cholangioscopy in the evaluation of difficult biliary strictures. Gastrointest Endosc 78:868–874

    Article  PubMed  Google Scholar 

  18. Tieu AH, Kumbhari V, Jakhete N, Onyimba F, Patel Y, Shin EJ, Li Z (2014) Diagnostic and therapeutic utility of SpyGlass peroral cholangioscopy in intraductal biliary disease: single-center, retrospective study. Dig Endosc. doi:10.1111/den.12405

    PubMed  Google Scholar 

  19. Moura EG, Franzini T, Moura RN, Carneiro FO, Artifon EL, Sakai P (2014) Cholangioscopy in bile duct disease: a case series. Arq Gastroenterol 51:250–254

    Article  PubMed  Google Scholar 

  20. Siiki A, Rinta-Kiikka I, Koivisto T, Vasama K, Sand J, Laukkarinen J (2014) SpyGlass single-operator peroral cholangioscopy seems promising in the evaluation of primary sclerosing cholangitis-related biliary strictures. Scand J Gastroenterol 49:1385–1390

    PubMed  Google Scholar 

  21. Woo YS, Lee JK, Oh SH, Kim MJ, Jung JG, Lee KH, Lee KT (2014) Role of SpyGlass Peroral Cholangioscopy in the evaluation of indeterminate biliary lesions. Dig Dis Sci 59:2565–2570

    Article  PubMed  Google Scholar 

  22. Chen YK, Parsi MA, Binmoeller KF, Hawes RH, Pleskow DK, Slivka A, Haluszka O, Petersen BT, Sherman S, Deviere 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

    Article  PubMed  Google Scholar 

  23. Fishman DS, Tarnasky PR, Patel SN, Raijman I (2009) Management of pancreaticobiliary disease using a new intra-ductal endoscope: the Texas experience. World J Gastroenterol 15:1353–1358

    Article  PubMed  PubMed Central  Google Scholar 

  24. Aljebreen AM, Alharbi OR, Azzam N, Almadi MA (2014) Efficacy of Spyglass-guided electrohydraulic lithotripsy in difficult bile duct stones. Saudi J Gastroenterol 20:366–370

    Article  PubMed  PubMed Central  Google Scholar 

  25. Kim HJ, Kim MH, Lee SK, Yoo KS, Seo DW, Min YI (2000) Tumor vessel: a valuable cholangioscopic clue of malignant biliary stricture. Gastrointest Endosc 52:635–638

    Article  CAS  PubMed  Google Scholar 

  26. Cotton PB, Eisen GM, Aabakken L, Baron TH, Hutter MM, Jacobson BC, Mergener K, Nemcek A Jr, Petersen BT, Petrini JL, Pike IM, Rabeneck L, Romagnuolo J, Vargo JJ (2010) A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 71:446–454

    Article  PubMed  Google Scholar 

  27. 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. doi:10.1016/j.gie.2015.04.030

    PubMed Central  Google Scholar 

  28. Draganov PV, Chauhan S, Wagh MS, Gupte AR, Lin T, Hou W, Forsmark CE (2012) Diagnostic accuracy of conventional and cholangioscopy-guided sampling of indeterminate biliary lesions at the time of ERCP: a prospective, long-term follow-up study. Gastrointest Endosc 75:347–353

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Liver and Biliopancreatic Disorders, University Hospital Gasthuisberg, K.U. Leuven, Louvain, Belgium

    Wim Laleman, Kristof Verraes, Werner Van Steenbergen, David Cassiman, Frederik Nevens, Schalk Van der Merwe & Chris Verslype

  2. Section of Liver and Biliopancreatic Disorders, Department of Gastroenterology, University Hospital Gasthuisberg, KU Leuven, Herestraat 49, 3000, Louvain, Belgium

    Wim Laleman

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  1. Wim Laleman
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  2. Kristof Verraes
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Correspondence to Wim Laleman.

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Disclosures

Drs. Kristof Verraes, Werner Van Steenbergen, David Cassiman, Chris Verslype and Frederik Nevens have no conflict of interest. Drs. Wim Laleman and Schalk Van der Merwe have served as a consultant for Boston Scientific. This paper is, however, the result of an investigator-driven initiative without any industry-related interference or sponsoring with regard to this report.

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Wim Laleman and Kristof Verraes share first authorship.

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Laleman, W., Verraes, K., Van Steenbergen, W. et al. Usefulness of the single-operator cholangioscopy system SpyGlass in biliary disease: a single-center prospective cohort study and aggregated review. Surg Endosc 31, 2223–2232 (2017). https://doi.org/10.1007/s00464-016-5221-2

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  • DOI: https://doi.org/10.1007/s00464-016-5221-2

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