NATIONAL RUSSIAN REGISTRY OF CHOLANGIO-PANCREATOSCOPY: MULTI-CENTER ASSESSMENT OF THE FIRST EXPERIENCE OF USING THE DIGITAL SINGLE-OPERATOR ENDOSCOPY OF BILIARY AND PANCREATIC DUCTS

Aims To evaluate possibilities and adverse events of diagnostic and therapeutic indirect peroral cholangiopancreatoscopy (POC)at the stage of implementation in Russia, using the national registry.

Methods From 06.12.2017 to 01.11.2019 in 4 clinics in Krasnodar (2), Moscow and St. Petersburg 109 interventions were performed in 101 patients (m-32, f-69; 27–89 years; average age 50.1±12.4 years) using SpyGlass DSsystem (BSC):84 cholangioscopies, 24 pancreaticoscopies and 1 cholangiopancreaticoscopy. The indications for cholangioscopy were: undifferentiated strictures (53), large stones (18), suspicion for Mirizzi syndrome (3), ‘difficult strictures’, after failure of cannulation under X-ray control (6), postoperative benign strictures (4); for pancreaticoscopy -pancreatic duct strictures, suspicious of malignancy (7) or IPMN (4), the need to introduce the guidewire under visual control (6) and large wirsungolite (6); for cholangiopancreatoscopy – assessment of the spread of major papilla tumor on bile and main pancreatic duct (1).

Results The overall technical success was 91.7% (100/109). Intraductal biopsy was successfully performed in 43/44 (97.7%) cases. Histological confirmation of the diagnosis of cholangiocarcinoma was obtained in 25/43 (58.1%) cases;in other 18/43 (41.9%) cases the strictures were benign. Therapeutic interventions were performed in all 40 cases (laser lithotripsy of bile duct stones – 7, electrohydraulic lithotripsyof bile duct stones – 11 and of pancreatic duct stones – 6, guidewire placement under visual control and further stenting – 12, removal of ligatures and clips of bile duct – 4). We had 3/101 (2.97%) complications – acute pancreatitis (2) and cholangitis (1). There were no deaths related to POC.

Conclusions The main indications for endoscopic peroralintraductal interventions are various types of undifferentiated and complicated strictures of the biliary tree and pancreatic ducts, as well as the ‘difficult’ bile and pancreatic duct stones. The technology of endoscopic interventions using the SpyGlass system is simple for ERCP specialists with comparable level of complications due to traditional transpapillary interventions.