CHOLANGIOSCOPY AND PANCREATOSCOPY ARE SAFE AND ARE ASSOCIATED WITH HIGH CLINICAL IMPACT

Aims:

Diagnosis and effective management of complex biliary and pancreatic duct abnormalities is challenging. We evaluate the utility of peroral cholangioscopy and pancretoscopy with targeted biopsy in these patients.

Methods:

Procedures were done under deep sedation by an anesthesiologist. An Olympus TJF-Q180V-duodenoscope and a disposable SpyGlass cholangioscope (Boston Scientific) were used. The advancement of the cholangioscope was accomplished after standard biliary or pancreatic papillotomy with insertion of a guide wire to the target area under fluoroscopy. Prophylactic antibiotics were used for all patients. All patients were selected for cholangioscopy after standard diagnostic and therapeutic techniques failed. Al procedures were performed by highly skilled and experienced endoscopists.

Results:

Since January 2016, 22 procedures (19 cholangioscopies and 3 pancreatoscopies) were done on 21 patients (9 Females).

Median age was 65.8 (range 31 – 86). The diagnostic findings (non-exclusive) were: biliary lithiasis in twelve patients, pancreatic lithiasis in 2, benign biliary strictures in 6, PSC with cholangiocarcinoma, malignant CBD polyp, IPMN and Intraductal papillary neoplasm, each in one patient. Stone extraction was performed in eleven patients. Five and one patients respectively underwent complete or partial laser lithotripsy and stone removal from the bile ducts and pancreatic duct. One patient underwent a polypectomy from the distal CBD. Eight biopsies were taken from the CBD and one from the PD. Malignancy and high grade dysplasia was confirmed in two cases and was ruled out in one. The mean duration was 65 (range 50 – 90) minutes. All patients recovered fully and no severe adverse events were seen.

Conclusions:

Cholangioscopy and pancreatoscopy is safe, was associated with high procedural success and may have clinical impact on the management of highly selected, complex cases.