The risk of post-ERCP pancreatitis after single operator peroral SpyGlass cholangioscopy is highest in the beginning of practice

Abstract

Background: SpyGlass cholangioscopy (SOC) with intra-ductal visualisation and biopsies is an adjunct to endoscopic retrograde cholangio-pancreatography (ERCP) in the diagnostics of indeterminate biliary strictures. The rate of complications during the learning curve and after establishment of a routine in SOC practice was studied. Methods: All consecutive SOC performed in a tertiary referral center 2012 – 2015 were included. Data was collected prospectively for indications, procedure details and complications and supplemented from records for clinical outcome. Results: 1920 ERCP were performed during the study period. Of those 113 patients (5.9%; mean age 58 y, 57% male) underwent SOC ERCP. Median follow-up was 19 months (range 1 – 48). The indication for SOC was primary sclerosing cholangitis in 43%, indeterminate stricture in 30% and stone disease in 24%. 92% of SOCs were performed in outpatient setting. In the very first 25 SOC, the rate of adverse events was 20%: all 5 patients had a severe post-ERCP pancreatitis (PEP), one of which had fatal outcome In the next 88 SOCs rate of adverse events was 8% (PEP 3%, cholangitis 3%, bleeding 1%, mortality 0%, none severe). The sensitivity and specificity of SOC biopsies were 75% and 87% for detecting cancer, respectively. Conclusion: The risk of pancreatitis after SOC decreases to the level seen in standard ERCP as experience accumulates. SOC may be considered a safe diagnostic aid in unclear biliary strictures even in outpatient setting.