Clinical Applications of the Spyglass Direct Visualization System: A Multicenter Experience

Abstract

biliary stricture (62%) and choledocholithiasis (21%). Other indications included pancreatic duct stones, evaluation of IPMN, suspected biliary mass, and surveillance for cholangiocarcinoma. The clinical diagnosis was altered by Spyglass in 24% of indeterminate biliary stricture cases, most commonly from suspected malignant stricture to benign stricture. One patient with biliary obstruction caused by a hepatic lesion suspicious for metastasis, was found to have a hepatic abscess that was treated endoscopically. Management of stones (8 biliary, 1 pancreatic) with laser or electrohydraulic lithotripsy was successful in all cases. Complete clearance in a single session was achieved in all but one case, in which a heavy stone burden necessitated additional sessions. Cholangioscopic visualization alone was adequate for diagnosis in only 7% of cases, while pancreatoscopic visualization alone was adequate in 2/3 cases. Biopsy was performed in 24 cases, and yielded adequate tissue for histologic evaluation in 88%. The endoscopists’ impression was that the Spyglass procedure contributed meaningfully to patient management in 86% of cases. Procedure related complications occurred in 5 patients: 1) hemorrhage following sphincterotomy; 2) post-ERCP cholecystitis; 3) pancreatitis following pancreatoscopy; 4) post-procedure abdominal pain; and 5) congestive heart failure. Conclusions: The Spyglass system allows single-operator choledochoscopy and pancreatoscopy, high yield, endoscopically directed tissue sampling.and facilitates biliary and pancreatic lithotripsy. The nature and frequency of complications are within the spectrum of those reported with other interventional pancreaticobiliary procedures