THE FIRST EXPERIENCE OF CHOLEDOCHOSCOPY USING SPYGLASS SYSTEM IN THE REPUBLIC OF BELARUS

Aims:

To share experience of performing choledochoscopy in various clinical situations.

Methods:

For the period from March 2017 to September 2018 in the Republican Center for Reconstructive Surgical Gastroenterology and Coloproctology, 15 choledochoscopies were performed in 15 patients aged 48 – 82 years (mean age 64.2). There were 3 men, 12 women. The indications for choledochoscopy were: suspicion of a neoplastic process – 3 patients; stones of bile duct with large size (more 20 mm) – 8 patients; suspected stones – 4 patients. The study was performed in an X-ray room or operating room using the SpyGlass endoscopic system of the Boston Scientific trademark. Laser lithotripsy was performed using laser setup with a 1440nm optical fiber with a power of 10 – 12 W.

Results:

A high degree of neoplasia with invasion into the wall of the common hepatic duct was confirmed in 1 case. The neoplastic process was excluded: in 1 patient stone was found in the wall of the common hepatic duct with severe perifocal inflammation and in 1 patient – an inflammatory stricture of the distal choledochus. Laser lithotripsy with complete extraction of calculi was successful in 3 patients after laparoscopic cholecystectomy with drainage of the common bile duct. Antegrade choledochoscopy with lithotripsy was performed on a patient with stricture Roux-en-Y hepaticojejunostomy. In 1 case choledochoscopy revealed a migrated plastic biliary stent among the stones. It was not possible to extract it endoscopically. In 3 cases, the control cholangioscopy was performed for evaluation the lumen after standart endoscopic lithotripsy. And in 4 cases the examination of the bile ducts was performed through the choledochhotomic opening while performing a laparoscopic choledochostomy.

Conclusions:

Thus, choledochoscopy using the SpyGlass system is a promising method in the diagnosis and treatment of surgical pathology of the biliary tree.