The Expansion of Cholangioscopy: Established and Investigational Uses of SpyGlass in Biliary and Pancreatic Disorders

Abstract

Direct visualization of bile and pancreatic duct pathology is proving to be beneficial in patients where previous techniques have failed. Recent advancements in technology and the development of the SpyGlass system have led to an increased use of cholangioscopy. It is already known that SpyGlass is beneficial in patients with difficult bile duct stones and indeterminate biliary lesions through the use of targeted lithotripsy and visually guided biopsy. Cholangioscopy allows the visualization of hidden stone and guide wire placement across difficult strictures and selective cannulation of the intrahepatic and cystic ducts. It is also demonstrating its utility in investigational applications such as post-liver transplant and primary sclerosing cholangitis stricture treatment, evaluation of hemobilia, and guided radiofrequency ablation of ductal tumors. In addition to having clinical utility, cholangioscopy may also be cost-effective by limiting the number of repeat procedures. Cholangioscopy overall has similar complication rates compared to other standard endoscopic retrograde cholangioscopy (ERCP) techniques, but there may be higher rates of cholangitis. This could be mitigated with prophylactic antibiotic use, and overall, cholangioscopy has similar complication rates compared to other techniques.

Single-operator peroral pancreatoscopy in the preoperative diagnostics of suspected main duct intraductal papillary mucinous neoplasms: efficacy and novel insights on complications

“…The complication rate in this study was 20%. Previous studies found total complication rates of 7 to 13% for peroral cholangiopancreatoscopies [32][33][34]. In our study, patients underwent pancreatoscopy, and no cholangioscopies were performed.…”

Clinical impact of a novel device delivery system in the diagnosis of bile duct lesions: A single‐center experience

“…We believe that this is due to the characteristics of this novel system: the inner catheter has a tapered shape and there is no difference in the outer diameter between the inner catheter and the outer sheath, which enables the system to pass through the biliary strictures smoothly and allows the biopsy forceps to easily and accurately reach the target site beyond the biliary strictures via the outer sheath, thus making it possible to evaluate the superficial extension of cancer cells in the peripheral bile duct (Video S2). In contrast, a cholangioscope may not be effective in evaluating such peripheral bile ducts because its non‐tapered form does not allow it to pass through the biliary stricture 25,26 . Furthermore, in mapping biopsies, care must be taken to avoid contamination of the cancer cells, which can cause incorrect assessments.…”

Post-cholecystectomy clip migration—a unique method of retrieval

“…This case shows the possibility of using lithotripsy with spyglass cholangioscopy as a potentially safer, non-invasive alternative to surgery in the treatment of refractory bile duct stones [ 13 , 14 ]. Furthermore, Spyglass cholangioscopy enables the endoscopist to directly visualize the bile duct for accurate diagnosis and treatment of pathology [ 13 , 15 ]. However, equipment availability and training requirements make its widespread use less feasible.…”