Usefulness of the single-operator cholangioscopy system SpyGlass in biliary disease: a single-center prospective cohort study and aggregated review.
Indeterminate biliary strictures and difficult bile duct stones remain clinically arduous and challenging situations. We aimed to evaluate the utility of the single-operator cholangioscopy (SOC)-system SpyGlass in both conditions in a single-center biliopancreatic interventional unit and in perspective of available aggregated literature.



Usefulness of SOC was assessed for the above-mentioned indications by means of the combination of successful procedural completion, clinical success and incidence of procedure-related adverse events in our own prospective cohort from 3/2010 to 7/2014 and all available literature till 6/2015.



Our single-center cohort constituted of 84 patients undergoing SpyGlass either for indeterminate strictures (n = 45) or difficult stones (n = 39). In addition, a comprehensive literature review yielded 851 patients (from 15 series) for either stenosis (n = 646, 75.9 %) and difficult stones (n = 205, 24.1 %). In our series, overall procedural success amounted to 85.7 % (with 88.9 % for stenosis or 82.1 % for stones) compared to 90.7, 91.5 and 88.3 % in overall literature, respectively. Sensitivity, specificity and accuracy for visual diagnosis in our cohort added up to 83.3, 82.9 and 82.9 % compared to 90.8, 90.9 and 90.8 % in the pooled analysis. Respective figures for SOC-directed biopsies totaled 85.7, 100 and 95.7 % in our cohort and 72.4, 100 and 84 % overall. Overall procedure-related complications varied between 9.4 and 21.4 %.



The SOC-platform SpyGlass can be considered useful in the context of indeterminate biliary strictures and difficult-to-remove biliary stones. In both, SpyGlass-assisted intervention is associated with high procedural success and alters clinical outcome compared to conventional approaches with an acceptable safety profile.
Department of Liver and Biliopancreatic Disorders, University Hospital Gasthuisberg, K.U. Leuven, Louvain, Belgium. wim.laleman@uzleuven.be.|Section of Liver and Biliopancreatic Disorders, Department of Gastroenterology, University Hospital Gasthuisberg, KU Leuven, Herestraat 49, 3000, Louvain, Belgium. wim.laleman@uzleuven.be.
Wim
0000-0002-0842-7813
W
Laleman
Department of Liver and Biliopancreatic Disorders, University Hospital Gasthuisberg, K.U. Leuven, Louvain, Belgium.
Kristof
K
Verraes
Department of Liver and Biliopancreatic Disorders, University Hospital Gasthuisberg, K.U. Leuven, Louvain, Belgium.
Werner
W
Van Steenbergen
Department of Liver and Biliopancreatic Disorders, University Hospital Gasthuisberg, K.U. Leuven, Louvain, Belgium.
David
D
Cassiman
Department of Liver and Biliopancreatic Disorders, University Hospital Gasthuisberg, K.U. Leuven, Louvain, Belgium.
Frederik
F
Nevens
Department of Liver and Biliopancreatic Disorders, University Hospital Gasthuisberg, K.U. Leuven, Louvain, Belgium.
Schalk
S
Van der Merwe
Department of Liver and Biliopancreatic Disorders, University Hospital Gasthuisberg, K.U. Leuven, Louvain, Belgium.
Chris
C
Verslype
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001660:Biliary Tract Diseases / Q000000981:diagnostic imaging* / Q000601:surgery; D001706:Biopsy / Q000379:methods; D002404:Catheterization / Q000379:methods; D002779:Cholestasis / Q000000981:diagnostic imaging; D016145:Endoscopy, Digestive System / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult
Cholangioscopy; Difficult bile duct stone; ERCP; Indeterminate biliary stenosis; Indeterminate stricture; Single-operator cholangioscopy; SpyGlass