Z Gastroenterol 2016; 54 - P27
DOI: 10.1055/s-0036-1584005

A multi-center retrospective study on the clinical value of two generations of a single-operator cholangioscope: analysis of 191 applications in 162 patients

W Dolak 1, R Schwarzer 2, U Itzlinger-Monshi 3, M Gschwantler 4, J Holzinger 5, U Olynetz 6, D Hubner 7, J Weber-Eibel 8, M Peck-Radosavljevic 8, B Stadler 7, K Jilek 6, P Herbst 5, B Hellmich 4, T Pachofszky 3, A Maieron 9, M Schöniger-Hekele 1, B Tribl 1, M Trauner 1, A Püspök 1, R Schöfl 2
  • 1Medical University Vienna, Internal Medicine III, Gastroenterology and Hepatology, Vienna, Austria
  • 2Elisabethinen Hospital Linz, Internal Medicine IV, Linz, Austria
  • 3Krankenanstalt Rudolfstiftung, Internal Medicine IV, Vienna, Austria
  • 4Wilhelminenspital, Internal Medicine IV, Vienna, Austria
  • 5Paracelsus University Salzburg, Surgery, Surgical Endoscopy, Salzburg, Austria
  • 6Landeskrankenhaus Hochsteiermark, Internal Medicine, Leoben, Austria
  • 7Klinikum Wels-Grieskirchen, Internal Medicine I, Wels, Austria
  • 8Klinikum Klagenfurt am Wörthersee, Internal Medicine, Klagenfurt, Austria
  • 9Elisabethinen Hospital Linz, Internal Medicine IV, Vienna, Austria

Background: Cholangioscopy provides direct visualization of the biliary tract by using ultra-slim endoscopes that can be introduced into the bile duct. The SpyGlass system is a catheter-based technology which can be used for diagnostic and therapeutic purposes by a single operator. Recently, a new generation of this technology has been launched.

Aims and Methods: This retrospective study aimed to evaluate the clinical value of SpyGlass cholangioscopy by analyzing consecutive examinations at eight Austrian referral centers for bilio-pancreatic endoscopy. Patients characteristics, indications, image quality from 1 (bad) to 10 (optimal) and outcome were assessed and compared between two SpyGlass generations (SpyGlass Legacy and SpyGlass DS).

Results: Over a ten-years period 191 consecutive examinations (138 Legacy, 53 DS) were performed in 162 patients (104 male, 58 female, median age 71 years, range 25 – 95 years). The main indication was evaluation of indeterminate strictures (68%), followed by cholangiolithiasis (24%). Prior to SpyGlass examinations, a majority of patients (84%) had already undergone a median number of 1 conventional ERCP examinations (range 1 – 10) with inconclusive or insufficient result. In 76% of stricture cases targeted biopsies were taken using the SpyBite biopsy forceps which had a diagnostic accuracy (according to the further clinical course) of 80%. In 85% of stone cases lithotripsy by targeting an endohydraulic or laser probe was successful (57% complete, 28% partial stone resolution). Image quality was rated 4 in median for the Legacy system and 8 in median for the DS system (p = 0.02, Fisher's exact test).

Conclusion: In this multi-center retrospective analysis cholangioscopy using the SpyGlass system was very effective for diagnosis and therapy of biliary disease. Image quality was rated much better for the new system, potentially resulting in an even higher diagnostic yield in the future.