Endoscopy 2019; 51(04): S229
DOI: 10.1055/s-0039-1681855
ESGE Days 2019 ePosters
Friday, April 5, 2019 09:00 – 17:00: ERCP ePosters
Georg Thieme Verlag KG Stuttgart · New York

THE FIRST EXPERIENCE OF INDIRECT PERORAL CHOLANGIO-PANCREATOSCOPY USING THE SPYGLASS DS SYSTEM (BSC) IN RUSSIA

D Bakhtiozina
1   Hospital Surgery, Laboratory of Endoscopy and Operative Gastroenterology, Pirogov RNRMU, Moscow, Russian Federation
,
S Budzinskiy
1   Hospital Surgery, Laboratory of Endoscopy and Operative Gastroenterology, Pirogov RNRMU, Moscow, Russian Federation
2   Moscow City Health Department, Moscow City Hospital No. 31, Moscow, Russian Federation
,
S Shapovalianz
1   Hospital Surgery, Laboratory of Endoscopy and Operative Gastroenterology, Pirogov RNRMU, Moscow, Russian Federation
2   Moscow City Health Department, Moscow City Hospital No. 31, Moscow, Russian Federation
,
E Fedorov
1   Hospital Surgery, Laboratory of Endoscopy and Operative Gastroenterology, Pirogov RNRMU, Moscow, Russian Federation
2   Moscow City Health Department, Moscow City Hospital No. 31, Moscow, Russian Federation
,
L Mikhaleva
2   Moscow City Health Department, Moscow City Hospital No. 31, Moscow, Russian Federation
3   Clinical Morphology, Research Institute of Human Morphology, Moscow, Russian Federation
,
P Chernyakevich
2   Moscow City Health Department, Moscow City Hospital No. 31, Moscow, Russian Federation
,
E Platonova
2   Moscow City Health Department, Moscow City Hospital No. 31, Moscow, Russian Federation
,
A Sorokin
4   Faculty of Fundamental Medicine, Lomonosov Moscow State University, Moscow, Russian Federation
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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    Aims:

    To evaluate possibilities of diagnostic and therapeutic peroral cholangiopancreatoscopy (POC).

    Methods:

    From December 6, 2017 to November 6, 2018, we performed 628 ERCP including 33 SpyGlass POCs in 31 patients: 30 cholangioscopies, 2 pancreaticoscopies and one cholangiopancreaticoscopy for assessment of the spread of major papilla tumor. The indications for cholangioscopy were: undifferentiated strictures – 22, Mirizzi syndrome – 2, control of bile duct stones extraction – 1, laser lithotripsy for choledocholithiasis – 2, guidewire placement – 2, removal of CBD ligature – 1; for pancreaticoscopy – strictures in chronic pancreatitis suspicious of malignancy – 2.

    Results:

    The overall technical success of the intervention was 97.0% (32/33). Intraductal biopsy with Spy-bite forceps was successfully performed in 17/18 (94.4%) planned cases. Histological confirmation of cholangiocarcinoma was obtained in 6 patients, including one in a patient with primary sclerosing cholangitis. Other strictures were benign. Divergence of endoscopic and histological diagnoses observed in 2 cases. Sensitivity of Spyglass visual diagnosis compared to Spy-bite histology was 83.3%, specificity 90.9%. Therapeutic interventions were successfully performed in all 5 patients, among them two laser lithotripsies of large bile duct stones with complete clearance of bile ducts. Indirect POC changed tactics in 15 patients. In comorbid patient with acute biliary pancreatitis and obstructive jaundice due to undifferentiated CBD stricture+choledocholithiasis the progression of pancreonecrosis leading to his death 3 days after EPST+POC was noted; however not directly related to SpyGlass. Overall morbidity and mortality was 3.22%.

    Conclusions:

    The main indications for endoscopic peroral intraductal 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. Diagnostic and therapeutic endoscopic interventions using the SpyGlass is promising technology, relatively easy to learn for ERCP specialists, with a level of complications and mortality comparable to traditional transpapillary interventions.


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