Endoscopy 2018; 50(04): S82
DOI: 10.1055/s-0038-1637271
ESGE Days 2018 oral presentations
21.04.2018 – ERCP 4: Advanced procedures (cholangioscopy, pancreas)
Georg Thieme Verlag KG Stuttgart · New York

INTRADUCTAL CHOLANGIOSCOPY AND PANCREATOSCOPY INDICATIONS AND RESULTS

A Taha
1   Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Hepato-Gastroenterology Department, Brussels, Belgium
,
R Garces Duran
1   Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Hepato-Gastroenterology Department, Brussels, Belgium
,
T Moreels
1   Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Hepato-Gastroenterology Department, Brussels, Belgium
,
R Yeung
1   Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Hepato-Gastroenterology Department, Brussels, Belgium
,
T Aouattah
1   Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Hepato-Gastroenterology Department, Brussels, Belgium
,
M Komuta
2   Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Pathology Department, Brussels, Belgium
,
H Piessevaux
1   Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Hepato-Gastroenterology Department, Brussels, Belgium
,
PH Deprez
1   Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Hepato-Gastroenterology Department, Brussels, Belgium
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

Also available at
 

Introduction:

The SpyGlass Direct Visualization System is a single-operator intraductal device used in diagnostic procedures as evaluation of indeterminate biliary strictures, intraductal papillary mucinous neoplasms of the pancreas, and therapeutic purposes as intraductal lithotripsy for difficult biliary or pancreatic duct stones.

Methods:

Retrospective review of direct cholangiopancreatoscopy in our center between 2007 and 2017.

Results:

78 consecutive patients were included: 71 direct cholangioscopy and 7 pancreatoscopy. The major indication of cholangioscopy was evaluation of indeterminate strictures (n = 35 (49.3%)), followed by difficult stones (n = 24 (33.8%), indeterminate filling defects (n = 7 (9.8%)), selective cannulation of the intrahepatic duct (n = 1 (1.4%)), suspicion of papillomatosis (n = 1 (1.4%)), extension of papillomatosis before surgery (n = 2 (2.8%)), intrahepatic migrated stent (n = 1 (1.4%)), dilated intrahepatic ducts with no obvious cause (n = 1 (1.4%)). The indication of pancreatoscopy was suspicion of IPMN (n = 5 (71.4%)) and migrated intraductal stent (n = 2 (28.6%)). Overall accuracy of visual findings for indeterminate stenosis in the cholangioscopy group was 88.56% with a sensitivity of 91.67%, specificity of 86.96%, PPV of 78.57% and NPV of 95.23%. The sensitivity and specificity for indeterminate filling defects were 100%. The sensitivity and specificity of pancreatoscopy in detecting IPMN were 100%. 43 patients underwent SpyGlass-directed biopsy (39 biliary, 4 pancreatic), the specimens from 42 patients (97.67%) were adequate for histologic evaluation. Overall technical success rate of therapeutic procedures such as laser lithotripsy, selective guidewire insertion or migrated stent removal was 100% in the cholangioscopy group however failure of extraction of the pancreatic stent was encountered in the pancreatoscopy group. Finally, adverse events were sepsis (10), pancreatitis (1), abdominal pain (1), cardiovascular event (1) and perforation with sub capsular abscess (1).

Conclusions:

Intraductal procedures carry a great value in diagnostic as well as therapeutic procedures in pancreatobiliary diseases, and tissue sampling is adequate for histologic diagnosis. It is a feasible and safe procedure now used in various indications.