SPYGLASS-CHOLANGIOSCOPY: ARE THE DAYS OF THE “BARIUM ENEMA OF THE BILIARY TREE” (ERCP) NUMBERED?

Aims Direct Cholangioscopy is a relatively new intervention that has been limited to use in Specialist centres. It has proved helpful for endoscopic management of gallstones and bile duct strictures. We present our experience of introducing SpyGlass-Cholangioscopy to our District General Hospital (DGH). We aim to assess applicability, feasibility and safety of SpyGlass-Cholangioscopy in a DGH setting in England, including a cost analysis compared with surgical bile duct exploration (an alternative for gallstones).

Methods Prospective data was collected for all ERCP patients with SpyGlass-Cholangioscopy between September 2018 and November 2021 using ERCP reports, discharge letters and medical records (number of ERCPs, complications, 30-day mortality, stone clearance at first SpyGlass, SpyBite sensitivity).

Results

Table 1

Indication	Patient number	Successful therapy at first procedure	Complications	SpyBite sensitivity
Bile Duct Stone	18	16	0
Hilar Biliary Stricture	7	7	1 (Cholangitis)	80% (4/5)
Biliopathy	2		0	100%
Common Bile Duct Stricture	1		0	100%

28 patients (10 Male, 18 Female) had 32 total procedures and collectively a total 47 previous ERCPs (mean 1.68). 11 patients required repeat ERCP, 4 with SpyGlass, 10 stent removals (8/10 pigtail-stents safe-guarding only, no stones left), 1 further stone removal (SpyGlass), 1 review of findings (resolved severe biliopathy). 1 patient had cholangitis (5.5%), with no other ERCP-related complications. 30-day mortality rate was 0%, reflecting a predominantly outpatient cohort. No patient required SpyGlass-ERCP referral to specialist centre. The nominal NHS cost of laparoscopic bile duct exploration for CBD-stone removal is £6,208 (plus bed-costs £1,775 per day) compared with £959 for day-case ERCP (plus average SpyScope and electrohydraulic lithotripsy costs £2,300).

Fig. 1 Gallbladder stone invading into CHD, resolution after SpyGlass-Cholangioscopy 9 months later

Conclusions Introduction of SpyGlass-Cholangioscopy to DGH setting was successful, safe, cost-efficient and avoided need for referral to specialist centres.

Publication History

Article published online:
14 April 2022