S3233 The Safety of Single Operator Per-Oral Cholangioscopy: A Single Center Experience

Abstract

INTRODUCTION: Single operator per-oral cholangioscopy (SOC) has been increasingly used to provide direct visualization of the biliary tree in conjunction with endoscopic retrograde cholangiopancreatography (ERCP). There is a prevalent notion that SOC increases the risk of pancreatitis and cholangitis in addition to the well-recognized complications of ERCP that also includes pancreatitis, cholangitis, bleeding, and perforation. This study aims to determine the rate of complications when SOC is performed. METHODS: This is a retrospective study which included consecutive adult (> 18 years old) patients who underwent ERCP with SOC from October 2017 until June 2020. SOC was performed utilizing SpyGlass Direct Visualization System. All procedures were performed by endoscopists who annually performed more than 200 ERCPs. Data on patient demographics, procedural indication, type, and complications were obtained. RESULTS: Thirty-three patients (male/female = 18/15) underwent a total of 35 ERCP with SOC procedures with an average of 67 years old. Most were Caucasian (64%) and the average body mass index was 25.3 kg/m2. Majority of the indications included choledocholithiasis (40%), indeterminate biliary stricture (34%), and imaging findings suspicious of cholangiocarcinoma (14%). A greater percentage underwent stone removal (66%), biopsy (46%) and lithotripsy (17%). 29 out of the 33 patients (88%) had previous ERCP. Despite administering rectal indomethacin in 60% (21/35) of the procedures and placement of pancreatic duct stent in 11% (4/35) of the procedures, 1 patient developed post-ERCP pancreatitis the day after the procedure. Pre-procedure intravenous antibiotics were given in 74% (26/35) and no patients developed cholangitis or died within the 30 days of follow-up. CONCLUSION: Although a few studies published in literature demonstrate a higher rate of procedural complications with ERCP and SOC compared to ERCP alone, this study suggests that SOC in addition to ERCP does not confer an additional procedural risk of pancreatitis or cholangitis. Our patient developed post-ERCP pancreatitis despite indomethacin and antibiotic use since balloon dilation and sphincterotomy were also performed which are known post-ERCP pancreatitis risk factors. SOC is a relatively safe procedure and should be performed in addition to ERCP in the evaluation of indeterminate biliary strictures and imaging suspicious of malignancy, and in the treatment of difficult biliary and pancreatic stones.Table 1.: Baseline Characteristics of the Study Population