Early Experience of Spyglass Discover Cholangioscope for Percutaneous And Intraoperative Cholangioscopy

Aims Peroral cholangioscopy may be a useful tool for targeted therapy of biliary stones and diagnosis of biliary strictures where a conventional retrograde endoscopic approach is not possible (eg. due to surgically altered anatomy). Previously available equipment was not designed or well suited to percutaneous cholangioscopy. The new SpyGlass Discover cholangioscope (Boston Scientific Inc) has been designed specifically for percutaneous or intraoperative use. The scope has a 65cm working length (compared to the longer, 214cm SpyScope DS II). The working channel is 3.6Fr, through which devices such as biopsy forceps and EHL probes can be passed.We describe our technique and early experience of using SpyGlass Discover in our joint tertiary centre since introduction of the system to the UK in July 2020.

Methods Percutaneous technique: Performed supine, under GAPrior PTBD is performed with tract dilated to 12Fr and matured for 7 days. At cholangioscopy the percutaneous drain is removed over a 260cm 0.035 wire. A 12Fr Peel Away sheath (Cook Medical) is inserted over the wire and into the biliary tree. The cholangioscope is advanced through this into the intrahepatic ducts (over the wire or freehand). Following cholangioscopy procedure an internal-external locking pigtail drain is left in situ, with subsequent tubogram and drain removal at 7 days if duct clear. Prophylactic antibiotics in all patients.

Results

Tab. 1

Age/gender:46 F	Indication:Cholangitis with intrahepatic stones above anastomotic stricture.	Anatomy:Hepatico-jejunostomy following bile duct injury	Procedure:Percutaneous Spy - Anastomotic stricture dilatation, cholangioscopy with EHL, balloon trawls	Outcome:Clear intrahepatic ducts.
47 M	Cholangitis with Intrahepatic stones and above anastomotic stricture.	Hepatico-jejunostomy for TB-related cholangiopathy.	Percutaneous Spy - Anastomotic stricture dilatation, cholangioscopy with EHL, balloon trawls	Clear intrahepatic ducts.
77 F	Recurrent cholangitis and large CBD stones	Partial gastrectomy	Percutaneous Spy - Anastomotic stricture dilatation, cholangioscopy with EHL, balloon trawls	Clear intrahepatic ducts.
68 M	PTBD in situ. Targeted tissue sampling and pre-surgical map.	Native anatomy	Percutaneous Spy - Cholangioscopic inspection of stricture. SpyBite biopsies.	Diagnosed intrahepatic CCA
80 M	Intrahepatic stones and stricture assessment, not accessible by peroral route	Native anatomy	Intra-operative Spy via cystic duct.- Cholangioscopic inspection of stricture, SpyBite biopsies, EHL of stones and balloon trawls	Diagnosed intrahepatic CCA and removed intrahepatic stones

Discussion In all 5 cases cholangioscopy was performed successfully and the intended therapy was completed. In one patient a small retained CBD stone at check tubogram was pushed into the small bowel without incident. There were no adverse events.

Conclusions We describe positive outcomes using the SpyGlass Discover scope for percutaneous and intra operative cholangioscopy. The short working length allows excellent responsiveness and manoeuvrability throughout the intra- and extra-hepatic ducts, producing a promising technology for conditions challenging or impossible to treat via a conventional approach.

Citation: Phillpotts S, Fateen W, Kok B et al. OP182 EARLY EXPERIENCE OF SPYGLASS DISCOVER CHOLANGIOSCOPE FOR PERCUTANEOUS AND INTRAOPERATIVE CHOLANGIOSCOPY. Endoscopy 2021; 53: S75.

Publication History

Article published online:
19 March 2021