Utility of the SPYGLASS Cholangiopancreatoscope (SCPS): An Initial Series of 26 Cases at a Tertiary Care Center

Abstract

Purpose: The SCPS is a recent innovation in which a single endoscopist is able to perform cholangiopancreatoscopy. The clinical utility of this new device has not been well studied. The goal of our study was to review our initial experience with the SCPS and assess its usefulness as a diagnostic and therapeutic tool. Methods: We retrospectively examined 26 cases using SPCS. All procedures were performed by one of three biliary endoscopist with experience in cholangioscopy. Success in imaging the desired ductal structures, in performing electrohydraulic lithotripy (EHL), and in guiding biopsy was assessed. Results: In 20 cases cholangioscopy utilized the Spyscope catheter and in 6 cases the SPYGLASS video fiber was passed through a triple lumen sphincterotome. The common duct (CBD) was examined in 25 cases and the pancreatic duct (PD) in 1. In 13 cases (group 1) the SCPS was used to evaluate potentially malignant strictures. There were 4 cases (group 2) where the SCPS was used for EHL of large CBD stones. In 9 cases (group 3) the SCPS was used in the diagnostic evaluation of various findings in the CBD or PD. In group 1 the Spyscope catheter was successfully used in 9/13 cases and the fiber/sphincterotome was used in 5/13 cases to visualize cbd strictures. Tissue was obtained in all pts by standard forceps, brushing, or the miniature Spy forceps (5/13 cases) and was diagnostic of malignancy in 4/13 pts. Spy forceps provided sufficient tissue in 4/5 biopsies, with 2 demonstrating mailignancy. In group 2 stones were visualized well and good placement of the EHL probe occurred in all cases. Stone pulverization only occurred in 1/3 patients (1/4 cases). In group 3 the Spyscope catheter was used in 7/9 cases and the fiber/sphincterotome in 2/9 cases. Examination ruled out stone, mass or stricture in 7/9 cases. Directed wire guided cannulation of an intrahepatic duct was performed in one case. A choledochal cyst was successfully sampled with Spy forceps in one case. SPCS examiniation was found to be clinically useful in all pts in group 3. Conclusion: Our initial use of the SCPS proved successful in evaluating complex biliary and pancreatic issues. Excellent visualization was achieved in all cases. SPCS added to our ability to biopsy malignant strictures, though the yield was lower than expected in this early experience. EHL was technically facilitated though two cases of very hard stones proved recalcitrant. SPCS was found to be clinically useful in the majority of cases.