P042] Single operator cholangioscopy reduces patient radiation exposure in the management of difficult bile duct stones and indeterminate bile duct structures: A single center comparison study

Abstract

Purpose Endoscopic Retrograde Cholangio-Pancreatography (ERCP) is a well-established endoscopic procedure for treatment or palliation of a great variety of hepatobiliary and pancreatic diseases, routinely performed using X-ray fluoroscopy. Due to extended fluoroscopy times and increased number of images, patient radiation doses can be high, especially in complex cases. A new digital single-operator cholangioscopy (D-SOC) system (SpyGlass Digital System, Boston Scientific), allows direct visualization of the ducts, targeted biopsies, visual wire manipulation and difficult stone lithotripsy in a radiation-free manner. We investigated whether the SpyGlass platform used adjunctively to ERCP may actually reduce patient radiation exposure. Methods We retrospectively analyzed a database of consecutive patients undergoing D-SOC following failure of ERCP either for difficult-to-treat biliary stones or indeterminate strictures. The overall patient radiation exposure outcomes in terms of Kerma Area Product (KAP), Fluoroscopy time (T) and the total number of films (F) were compared to a historical cohort of patients with difficult stones or indeterminate strictures exclusively managed by conventional ERCP before the era of D-SOC. All procedures were performed by a single, experienced operator. Results Between 2016 and 2017, a total of 16 patients underwent successful D-SOC management of difficult biliary stones (n = 11) or indeterminate strictures (n = 5). The historical cohort comprised 20 patients with difficult-to-treat stones (n = 12) or indeterminate strictures (n = 8) who were successfully managed by repeat conventional ERCP between 2012 and 2015. Median KAP, T and F in patients undergoing D-SOC were 11.8 Gycm2; 4.2 min and 1.6 films respectively, compared with 17 Gycm2; 5.8 min, and 2.6 films respectively in the historical ERCP cohort. Statistically significant differences (P Conclusions Adjunct use of the new SpyGlass cholangioscopy platform significantly reduces radiation exposure in patients with difficult stones or indeterminate strictures in whom conventional ERCP has failed.