Abstract
(81%) yielding sufficient samples whereas POC-directed biopsies were performed in 72/174 (41%) with 54/72 (75%) yielding sufficient samples. The sensitivity, specificity, positive and negative predictive values, and accuracy of POC with/ without tissue sampling for the diagnosis of malignant lesions were 70%, 97%, 93%, 87%, and 89%, respectively. Twenty-six out of 38 (68%) malignant lesions were correctly identified at Spyglass POC (with or without tissue confirmation). In all, 27 EHL procedures were performed in 25 patients. Bile duct clearance was achieved in 17/25 (68%) with a further 2/25 (8%) awaiting further procedures. There were 14/174 (8%) adverse events (9 cholangitis/sepsis, 1 postsphincterotomy bleed, 3 hypotension, 1 pancreatitis). Two adverse events were severe (1 death due to sepsis; 1 ITU admission due to pancreatitis), one moderate (sepsis) and the rest were mild.Conclusions In experienced hands, Spyglass POC is very accurate in the diagnosis of malignant biliary lesions and effective for the treatment of bile duct stones not amenable to conventional endoscopic therapy. The complication rate is comparable to that of conventional ERCP with sepsis being the most common adverse event.
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