Evaluation of the SpyGlass Discover Digital Catheter in Biliary Diagnostics and Therapy

Background: Percutaneous transhepatic cholangiodrainage (PTCD) is an established procedure for bile drainage, when endoscopic retrograde cholangiography (ERC) fails or is not feasible due to altered anatomy. However, diagnostic and interventional options are limited using fluoroscopy only. Percutaneous transhepatic cholangioscopy offers direct visualization, guiding both diagnostic and therapeutic procedures. The SpyGlass Discover Digital Catheter, a new, short, single-use cholangioscopy catheter, may enhance sterility and ease of use with its 65cm length and 1.2 mm working channel.

Methods: In this retrospective study, we analyzed 22 percutaneous transhepatic cholangioscopies performed using the SpyGlass Discover system (Boston scientific). All patients received pre-interventional antibiotic prophylaxis. Guide-wire-and fluoroscopy-assisted, the drainage was removed and a 12 French peel away sheath was placed to maintain biliary access. The SpyGlass Discover catheter was then inserted through the sheath, deeply into the biliary and enteric system during constant flushing.

Results: Among all patients, PTCD was performed following ERC failure due to altered anatomy and inaccessible biliodigestive anastomosis/papilla vateri (n=19; 86.36%) or significant stenosis of intrahepatic bile ducts following atypical hepatic resection (n=3; 13.64%). Cholangioscopy was predominantly diagnostic, with forceps biopsy in 40.91% of cases (n=9/22). Therapeutically, cholangioscopy aided a precise placement of a self-expanding metal or biodegradable stent (n=19; 18.18%) and PTCD internalization (n=3; 13.64%). Choledocholithiasis was treated with cholangioscopy in 5 cases (22.73%), with 4 cases (18.18%) using electrohydraulic lithotripsy (EHL) and in one case with flushing the gallstone into the small intestine. Median procedure time was 59 minutes (IQR 109-31). No severe adverse events were observed. Post-interventional cholangitis occurred in 5 patients (22.73%) and localized peritonitis in one patient (4.55%), all resolved with antibiotics. Technical and clinical success rates were 100% and 95.45% respectively, with one failed PTCD internalization requiring a subsequent rendezvous procedure.

Conclusion: Percutaneous transhepatic cholangioscopy with a single-use catheter demonstrates high technical and clinical success rates. Post-interventional cholangitis remains a frequent adverse event, emphasizing the importance for pre-interventional antibiotics.

Publication History

Article published online:
26 September 2024