Endoscopy 2018; 50(04): S82-S83
DOI: 10.1055/s-0038-1637272
ESGE Days 2018 oral presentations
21.04.2018 – ERCP 4: Advanced procedures (cholangioscopy, pancreas)
Georg Thieme Verlag KG Stuttgart · New York

DIGITAL VS FIBEROPTIC CHOLANGIOSCOPY

I Dimas
1   Venizeleion General Hospital of Heraklion, Department of Gastroenterology, Heraklion, Greece
,
E Vardas
1   Venizeleion General Hospital of Heraklion, Department of Gastroenterology, Heraklion, Greece
,
M Fragaki
1   Venizeleion General Hospital of Heraklion, Department of Gastroenterology, Heraklion, Greece
,
A Mpitouli
1   Venizeleion General Hospital of Heraklion, Department of Gastroenterology, Heraklion, Greece
,
M Velegraki
1   Venizeleion General Hospital of Heraklion, Department of Gastroenterology, Heraklion, Greece
,
E Voudoukis
1   Venizeleion General Hospital of Heraklion, Department of Gastroenterology, Heraklion, Greece
,
A Theodoropoulou
1   Venizeleion General Hospital of Heraklion, Department of Gastroenterology, Heraklion, Greece
,
G Paspatis
1   Venizeleion General Hospital of Heraklion, Department of Gastroenterology, Heraklion, Greece
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

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Aims:

Digital cholangioscopes provide higher-resolution imaging of the pancreatobiliary tract compared with the fiberoptic instruments. The aim of the study was primarily to assess the frequency of digital cholangioscopy (DC) to alter diagnosis and clinical management of bile duct disease compared with fiberoptic cholangioscopy (FC), and secondly to correlate the results of technical success according to the difficulty of the procedure.

Methods:

A retrospective review of 68 cases performed in our department was conducted. The aim of cholangioscopy was to confirm Endoscopic Retrograde Cholangiography (ERC) diagnosis, obtain adequate biopsy specimens for histological evaluation and remove biliary stones. From 5/2009 to 8/2015 cholangioscopies were performed with FC. From 9/2015 to 3/2017 cholangioscopies were performed with DC. The Grade of Difficulty of ERC procedure (1 – 4) and the Technical Success (Yes/No) were assessed using criteria adapted from Cotton et al, Gastrointestinal Endoscopy 2011 and Ogura et al, Digestive Endoscopy 2017 respectively.

Results:

68 patients underwent cholangioscopy. FC was performed in 39 cases and DC in 29 cases, obtaining biopsies for malignancy in 11 and 15 cases respectively. Biopsy confirmed the endoscopic diagnosis in one FC case (9,1%), in contrast with 10 cases of DC-guided biopsies (66,7%). The initial diagnosis and clinical management (e.g. cancer diagnosis, successful EHL lithotripsy) was altered after cholangioscopy in 13 DC cases (44,8%), in contrast with 11 cases of FC (28,2%). Moreover, technical success (regardless of the grade of difficulty) was better assured (75,8%) by the use of DC rather than FC (56,4%).

Conclusions:

Our data suggest that DC has overcome the impediment of fiberoptic technology, providing increased sensitivity and specificity for visual impression diagnosis of malignancy and successful therapy of biliary stones. Moreover DC has the ability to alter more often the initial ERC diagnosis or management compared to FC, achieving higher rates of technical success.