A Single Institutionʼs Initial Experience with Spyglass™ in the Diagnosis and Management of Biliary Disease during ERCP

Abstract

Purpose: To evaluate the clinical utility, safety and ease of use of SpyGlass™ (a single-operator peroral cholangiopancreatoscopy system) during endoscopic retrograde cholangiopancreotography (ERCP). Methods: A retrospective chart review was performed of the ERCP cases during which Spyglass™ was used. For each case, the following outcomes were assessed: success of introducing the device into the bile duct; successful identification of filling defects; use and success of electrohydraulic lithotripsy (if performed); use and success of directly visualized forceps biopsies; and yield of biopsies. Results: Spyglass™ cholangiopancreatoscopy was attempted in 6 patients. A single operator performed each case. Indications for Spyglass™ included: unexplained abdominal pain of suspected biliary origin (N = 1) and filling defects seen on initial cholangiogram [suspected choledocolithiasias (N = 3) and malignant stricture (N = 2)]. Cannulation with Spyglass™ was successful in 5 of 6 patients (83.3%). The single failed cannulation was due to difficult anatomy from a suspected malignant biliary stricture in the distal common bile duct. Identification of filling defects was achieved in 4 of the 5 successful cannulations (3 with stones, 1 with malignancy). Biopsies were performed in 1 case with a successful diagnosis of a ductal carcinoma. Therapy using electrohydraulic lithotripsy (EHL) via the Spyglass™ device was attempted in 2 patients (1 with a common bile duct stone, 1 with a cystic duct stone). Partial clearance was achieved in each case. Failure of successful lithotripsy was due to (1) the size of the common bile duct stone and (2) inability to maintain good stone to EHL probe contact in the cystic duct. No procedure related complications occurred. Conclusion: In this small retrospective review, the Spyglass system demonstrated adequate visualization of the biliary tree to facilitate the diagnosis of biliary strictures and lithotripsy of large CBD stones during ERCP. Further investigation to identify the optimum patient characteristics for cholangiopancreatoscopy with this system is required and ongoing.