Digital per-oral cholangioscopy to diagnose and manage biliary duct disorders: a single-center retrospective study

Abstract

Background and study aims Digital, per-oral cholangioscopy (POCS) allows diagnosis of biliary ducts disorders and treatment for complicated stones. We aimed to determine the diagnostic accuracy of digital POCS systems for stricture lesions and the factors precluding complete biliary stone clearance. Patients and methods We performed a retrospective analysis of a prospective database of 265 consecutive patients referred for POCS between December 2016 and July 2018. We first analyzed the diagnostic accuracy of digital POCS for malignant and benign stricture lesions in 147 patients. Then, we analyzed the factors associated with complete or partial biliary stone clearance achieved with electrohydraulic lithotripsy (EHL) delivered via POCS in 118 patients. Results In the diagnostic group, digital POCS achieved 91 % visual-impression sensitivity, 99 % specificity, 99 % positive and 91 % negative predictive values, and 63.64 positive and 0.09 negative likelihood ratios for malignancy diagnosis. In the therapeutic group, complete biliary stone clearance was achieved by EHL in 94.9 % patients; the mean stone size was 20 mm (10–40 mm). In multivariable analyses, a stone size > 20 mm (OR: 1.020, P < 0.001) and the number of stones ≥ 3 (OR: 1.276, P < 001) was associated with partial biliary stone clearance. Adverse events were reported in 3.3 % patients; no deaths were reported 30 days after the procedure. Conclusions Digital POCS has excellent diagnostic efficacy for biliary lesions. EHL via POCS is effective for complicated biliary stone clearance. Stone size (> 20 mm) and the number of stones (≥ 3) are associated with partial biliary stone clearance.

Prospective registration study of diagnostic yield and sample size in forceps biopsy using a novel device under digital cholangioscopy guidance with macroscopic on‐site evaluation

“…In the 290 procedures performed, sensitivity, specificity, and overall accuracy of POCS visualization were 86.7 (95% CI: 79.1%‐92.4%), 71.2% (95% CI: 63.9%‐77.7%), and 77.2% (95% CI: 72.0%‐81.9%), respectively. Robles‐Medranda et al 20 also reported excellent results in their single‐center retrospective study. They included a total 265 consecutive patients who were complicated with indeterminate biliary stricture.…”

Experiencia en colangioscopia digital peroral con SpyGlass DS en diferentes centros de referencia en gastroenterología y endoscopia digestiva en Colombia: Serie de casos

“…No se registraron muertes a los 30 días del procedimiento, la estancia media postoperatoria fue de 2,04 días y la tasa de eventos adversos fue del 2,5%. Las altas tasas de resolución, la tasa de eventos adversos y la disminución de los tiempos de estancia intrahospitalaria se acercan a estudios anteriores (17,26,27) , por lo que es una alternativa a tener en cuenta en el protocolo de manejo de los pacientes con indicación de esta tecnología. Mientras que, las tasas de colangitis aguda post-CPO es baja, en relación a prácticas como la administración intravenosa de antibióticos y el drenaje nasobiliar (17,26,28) .…”

“…Las altas tasas de resolución, la tasa de eventos adversos y la disminución de los tiempos de estancia intrahospitalaria se acercan a estudios anteriores (17,26,27) , por lo que es una alternativa a tener en cuenta en el protocolo de manejo de los pacientes con indicación de esta tecnología. Mientras que, las tasas de colangitis aguda post-CPO es baja, en relación a prácticas como la administración intravenosa de antibióticos y el drenaje nasobiliar (17,26,28) . La comparación entre el uso de la litotricia con el láser o la LEH no muestra grandes diferencias en sus resultados.…”

The Usefulness of Peroral Cholangioscopy for Intrahepatic Stones

“…Before the advent of SpyGlass, the complete stone removal rate for intrahepatic stones by POCS was 64% [ 7 ]. In reports of POCS for common bile duct stones and not limited to intrahepatic stones, the complete removal rate of stones was 82–95% [ 8 , 9 ]. In our study, CSR was achieved in 94% (15/16) of cases in which POCS was performed, which is considered a good result.…”