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Clinical impact of digital cholangioscopy in management of indeterminate biliary strictures and complex biliary stones: a single-center study
AIMS: Endoscopic management of indeterminate strictures and complex stones remains a challenge, for which the latest generation single-operator digital cholangioscope (SpyGlass DS) has shown promising results. We aimed to study the clinical impact of single-operator digital cholangioscope at our ter...
Autores principales: | , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6563398/ https://www.ncbi.nlm.nih.gov/pubmed/31218297 http://dx.doi.org/10.1177/2631774519853160 |
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author | Yan, Stephanie Tejaswi, Sooraj |
author_facet | Yan, Stephanie Tejaswi, Sooraj |
author_sort | Yan, Stephanie |
collection | PubMed |
description | AIMS: Endoscopic management of indeterminate strictures and complex stones remains a challenge, for which the latest generation single-operator digital cholangioscope (SpyGlass DS) has shown promising results. We aimed to study the clinical impact of single-operator digital cholangioscope at our tertiary academic center. METHODS: We retrospectively reviewed all digital cholangioscopies performed from June 2015 to May 2018. Patient characteristics, procedure characteristics, and post-procedural patient outcomes were recorded. RESULTS: A total of 50 patients (26 men, average age 61.4 years) underwent 67 procedures. Indications were biliary stones (21/50, 42%), strictures and primary sclerosing cholangitis surveillance (22/50, 46%), and miscellaneous (7/50, 14%). The average procedure time was 82 ± 29 min (99.5 min for stones and 74.2 min for strictures). Stone clearance was achieved in 19/21 (90.47%) cases, with electrohydraulic lithotripsy employed in 16/21 and repeat cholangioscopy necessary in 9/21. Malignant strictures (10) were differentiated from benign (12) in all cases both in patients with primary sclerosing cholangitis (9) and in those without (13), based on visual cholangioscopic features (sensitivity and specificity 100%), single-operator digital cholangioscope–directed biopsies (sensitivity 60% and specificity 100%), and brush cytology (sensitivity 37.5% and specificity 100%). Complications included one post-sphincterotomy bleeding and one post-procedural cholangitis despite antibiotic prophylaxis, but no procedure-related mortality. CONCLUSION: Single-operator digital cholangioscope had a high success rate and a low rate of complications for management of indeterminate strictures and difficult biliary stones. Visual cholangioscopic features of biliary strictures had excellent diagnostic accuracy, and targeted biopsies outperformed brush cytology. Early implementation of cholangioscopy for select indications leads to successful patient outcomes and reduces diagnostic delays, cost, and risks of repeat endoscopic retrograde cholangiopancreatographies. |
format | Online Article Text |
id | pubmed-6563398 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-65633982019-06-19 Clinical impact of digital cholangioscopy in management of indeterminate biliary strictures and complex biliary stones: a single-center study Yan, Stephanie Tejaswi, Sooraj Ther Adv Gastrointest Endosc Original Research AIMS: Endoscopic management of indeterminate strictures and complex stones remains a challenge, for which the latest generation single-operator digital cholangioscope (SpyGlass DS) has shown promising results. We aimed to study the clinical impact of single-operator digital cholangioscope at our tertiary academic center. METHODS: We retrospectively reviewed all digital cholangioscopies performed from June 2015 to May 2018. Patient characteristics, procedure characteristics, and post-procedural patient outcomes were recorded. RESULTS: A total of 50 patients (26 men, average age 61.4 years) underwent 67 procedures. Indications were biliary stones (21/50, 42%), strictures and primary sclerosing cholangitis surveillance (22/50, 46%), and miscellaneous (7/50, 14%). The average procedure time was 82 ± 29 min (99.5 min for stones and 74.2 min for strictures). Stone clearance was achieved in 19/21 (90.47%) cases, with electrohydraulic lithotripsy employed in 16/21 and repeat cholangioscopy necessary in 9/21. Malignant strictures (10) were differentiated from benign (12) in all cases both in patients with primary sclerosing cholangitis (9) and in those without (13), based on visual cholangioscopic features (sensitivity and specificity 100%), single-operator digital cholangioscope–directed biopsies (sensitivity 60% and specificity 100%), and brush cytology (sensitivity 37.5% and specificity 100%). Complications included one post-sphincterotomy bleeding and one post-procedural cholangitis despite antibiotic prophylaxis, but no procedure-related mortality. CONCLUSION: Single-operator digital cholangioscope had a high success rate and a low rate of complications for management of indeterminate strictures and difficult biliary stones. Visual cholangioscopic features of biliary strictures had excellent diagnostic accuracy, and targeted biopsies outperformed brush cytology. Early implementation of cholangioscopy for select indications leads to successful patient outcomes and reduces diagnostic delays, cost, and risks of repeat endoscopic retrograde cholangiopancreatographies. SAGE Publications 2019-06-12 /pmc/articles/PMC6563398/ /pubmed/31218297 http://dx.doi.org/10.1177/2631774519853160 Text en © The Author(s), 2019 http://www.creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Original Research Yan, Stephanie Tejaswi, Sooraj Clinical impact of digital cholangioscopy in management of indeterminate biliary strictures and complex biliary stones: a single-center study |
title | Clinical impact of digital cholangioscopy in management of indeterminate biliary strictures and complex biliary stones: a single-center study |
title_full | Clinical impact of digital cholangioscopy in management of indeterminate biliary strictures and complex biliary stones: a single-center study |
title_fullStr | Clinical impact of digital cholangioscopy in management of indeterminate biliary strictures and complex biliary stones: a single-center study |
title_full_unstemmed | Clinical impact of digital cholangioscopy in management of indeterminate biliary strictures and complex biliary stones: a single-center study |
title_short | Clinical impact of digital cholangioscopy in management of indeterminate biliary strictures and complex biliary stones: a single-center study |
title_sort | clinical impact of digital cholangioscopy in management of indeterminate biliary strictures and complex biliary stones: a single-center study |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6563398/ https://www.ncbi.nlm.nih.gov/pubmed/31218297 http://dx.doi.org/10.1177/2631774519853160 |
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