The Usefulness of SpyGlass™ Choledochoscopy in the Diagnosis and Treatment of Biliary Disorders

Abstract

Peroral choledochoscopy was first described in the 1970s, but the use of earlier generation choledochoscopes was significantly limited by complex equipment setup and fragility resulting in high repair costs. In late 2006, the SpyGlass Direct Visualization System (Boston Scientific Corp, Natick, MA, USA) was introduced to the market. It is a single-operator cholangioscopy platform and improves upon many shortcomings of the dual-operator systems. Currently, the two main indications for its use are evaluation of indeterminate biliary strictures and lithotripsy for difficult-to-remove biliary stones. Recently published prospective data reconfirm that the overall success rates for adequate tissue sampling and bile duct stone clearance are around 90 %, with an acceptable safety profile. The sensitivity for detecting cancer in intrinsic biliary strictures (e.g., cholangiocarcinoma) is superior to that of standard ERCP sampling modalities, but a limited yield has been noted when sampling extrinsic malignant biliary strictures (e.g., pancreatic cancer). The two main limitations of the SpyGlass system are image quality that is impeded by the use of fiberoptic technology and a relatively small accessory channel providing passage only for dedicated miniaccessories. Nevertheless, the SpyGlass platform has made single-operator cholangioscopy feasible and refined the technique in a number of important ways. This innovation has significantly expanded our diagnostic and therapeutic ERCP armamentarium. An upgraded digital imaging version is currently in development.

Peroral Cholangiopancreatoscopy with the SpyGlass® System: What do we Know 10 Years Later

“…However, intraductal endoscopy is generally believed to be a safe procedure with relatively few complications that are comparable to those reported for ERCP [45]. These potential complications associated with cholangioscopy are numerous and range from relatively mild life-threatening sequelae conditions, including the following: cholangitis (most common complication), bacteremia, abdominal pain, pancreatitis, hypotension, nausea, liver abscess, radiculopathy, bile duct drilling (from the guide-wire), amylase and lipase elevation without clinical pancreatitis, and systemic inflammatory syndrome [45]. In a retrospective study including 402 ERCPs with cholangioscopy (a minority with SpyGlass® system) of a total of 3475 ERCPs, there was a higher rate of adverse events in the combination group (7% vs. 2.9%) [46].…”

“…Intraductal endoscopy can assist in removing these difficult stones, by allowing direct visualization and guiding lithotripsy. Furthermore, standard fluoroscopy based cholangiograms routinely loosen remaining stones or stone fragments after lithotripsy [24]. Parsi et al [25] were able to diagnose at least 29% of ERCP-lost gallstones by later cholangioscopy, leading them to conclude that the lost stones rates in ERCP may be higher than previously thought.…”

Interobserver Agreement for Single Operator Choledochoscopy Imaging: Can We Do Better?

“…It has been shown that direct visualization with the cholangioscopy system improves the accuracy of cholangiographic findings in evaluating patients with biliary obstructive symptoms of indeterminate origin [3, 4, 12–15]. Cholangioscopy also allows for obtaining biopsies under direct visualization.…”

Triple-Tissue Sampling during Endoscopic Retrograde Cholangiopancreatography Increases the Overall Diagnostic Sensitivity for Cholangiocarcinoma

“…Recently, new methods, such as endoscopic ultrasound-guided FNA or spyglass cholangioscopy, have been introduced for evaluating biliary strictures 19–21. However, we consider that tissue sampling, particularly TTS, would continue to be an essential procedure with its easy feasibility and safety.…”