Download PDF
CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(11): E1704-E1711
DOI: 10.1055/a-1535-1458
Original article

Clinical practice patterns in indirect peroral cholangiopancreatoscopy: outcome of a European survey

Pauline M.C. Stassen
1   Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
,
Pieter Jan F. de Jonge
1   Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
,
George J.M. Webster
2   Department of Gastroenterology, University College London Hospitals, London, United Kingdom
,
Mark Ellrichmann
3   Department of Interdisciplinary Endoscopy, Medical Department 1, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
,
Arno J. Dormann
4   Department of Gastroenterology, GI Oncology, GI-ID, Nutritional Medicine, Kliniken der Stadt Köln, Köln, Germany
,
Marianne Udd
5   Department of Gastroenterological Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
,
Marco J. Bruno
1   Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
,
Vincenzo Cennamo
6   Gastroenterology and Interventional Endoscopy Unit, Local Health Authority of Bologna, Bologna, Italy
,
on behalf of the European Cholangioscopy Group, and the German Spyglass User Group › Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background and aims Indirect peroral cholangiopancreatoscopy (IPOC) is a relatively new diagnostic and therapeutic tool for biliopancreatic diseases. This international survey aimed to evaluate clinical practice patterns in IPOC among endoscopists in Europe.

Methods An online survey was developed comprising 66 questions on the use of IPOC. Questions were grouped into four domains. The survey was sent to 369 endoscopists who perform IPOC.

Results 86 respondents (23.3 %) from 21 different countries across Europe completed the survey. The main indications for cholangioscopy were determination of biliary strictures (85 [98.8 %]) and removal of common bile duct or intrahepatic duct stones (79 [91.9 %]), accounting for an estimated use of 40 % (interquartile range [IQR] 25–50) and 40 % (IQR 30–60), respectively, of all cases undergoing cholangioscopy. Pancreatoscopy was mainly used for removal of pancreatic duct stones (68/76 [89.5 %]), accounting for an estimated use of 76.5 % (IQR 50–95) of all cases undergoing pancreatoscopy. Only 13/85 respondents (15.3 %) had an institutional standardized protocol for targeted cholangioscopy-guided biopsy sampling. IPOC with lithotripsy was used as first-line treatment in selected patients with bile duct stones or pancreatic stones by 24/79 (30.4 %) and 53/68 (77.9 %) respondents, respectively.

Conclusions This first European survey on the clinical practice of IPOC demonstrated wide variation in experience, indications, and techniques. These results emphasize the need for prospective studies and development of an international consensus guideline to standardize the practice and quality of IPOC.

Supplementary material



Publication History

Received: 23 March 2021

Accepted: 07 June 2021

Article published online:
12 November 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Ghersi S, Fuccio L, Bassi M. et al. Current status of peroral cholangioscopy in biliary tract diseases. World J Gastrointest Endosc 2015; 7: 510-517
    CrossrefPubMedSearch in Google Scholar
  • 2 Komanduri S, Thosani N. ASGE Technology Committee. et al. Cholangiopancreatoscopy. Gastrointest Endosc 2016; 84: 209-221
    CrossrefPubMedSearch in Google Scholar
  • 3 Tringali A, Lemmers A, Meves V. et al. Intraductal biliopancreatic imaging: European Society of Gastrointestinal Endoscopy (ESGE) technology review. Endoscopy 2015; 47: 739-753
    Thieme ConnectPubMedSearch in Google Scholar
  • 4 de Oliveira P, de Moura DTH, Ribeiro IB. et al. Efficacy of digital single-operator cholangioscopy in the visual interpretation of indeterminate biliary strictures: a systematic review and meta-analysis. Surg Endosc 2020; 34: 3321-3329
    CrossrefPubMedSearch in Google Scholar
  • 5 Sethi A, Tyberg A, Slivka A. et al. Digital single-operator cholangioscopy (DSOC) improves interobserver agreement (IOA) and accuracy for evaluation of indeterminate biliary strictures: the Monaco classification. J Clin Gastroenterol 2020;
    CrossrefPubMedSearch in Google Scholar
  • 6 Kalaitzakis E, Webster GJ, Oppong KW. et al. Diagnostic and therapeutic utility of single-operator peroral cholangioscopy for indeterminate biliary lesions and bile duct stones. Eur J Gastroenterol Hepatol 2012; 24: 656-664
    CrossrefPubMedSearch in Google Scholar
  • 7 Gerges C, Beyna T, Tang RSY. et al. Digital single-operator peroral cholangioscopy-guided biopsy sampling versus ERCP-guided brushing for indeterminate biliary strictures: a prospective, randomized, multicenter trial (with video). Gastrointest Endosc 2020; 91: 1105-1113
    CrossrefPubMedSearch in Google Scholar
  • 8 Varadarajulu S, Bang JY, Hasan MK. et al. Improving the diagnostic yield of single-operator cholangioscopy-guided biopsy of indeterminate biliary strictures: ROSE to the rescue? (with video). Gastrointest Endosc 2016; 84: 681-687
    CrossrefPubMedSearch in Google Scholar
  • 9 Ali S, Hawes RH, Kadkhodayan K. et al. Utility of rapid onsite evaluation of touch imprint cytology from endoscopic and cholangioscopic forceps biopsy sampling (with video). Gastrointest Endosc 2019; 89: 340-344
    CrossrefPubMedSearch in Google Scholar
  • 10 European Study Group on Cystic Tumours of the Pancreas. European evidence-based guidelines on pancreatic cystic neoplasms. Gut 2018; 67: 789-804
    CrossrefPubMedSearch in Google Scholar
  • 11 Tyberg A, Raijman I, Siddiqui A. et al. Digital pancreaticocholangioscopy for mapping of pancreaticobiliary neoplasia: can we alter the surgical resection margin?. J Clin Gastroenterol 2019; 53: 71-75
    CrossrefPubMedSearch in Google Scholar
  • 12 Pereira P, Santos S, Morais R. et al. Role of peroral cholangioscopy for diagnosis and staging of biliary tumors. Dig Dis 2020; 38: 431-440
    CrossrefPubMedSearch in Google Scholar
  • 13 Dumonceau JM, Delhaye M, Tringali A. et al. Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – updated August 2018. Endoscopy 2019; 51: 179-193
    Thieme ConnectPubMedSearch in Google Scholar
  • 14 McCarty TR, Sobani Z, Rustagi T. Per-oral pancreatoscopy with intraductal lithotripsy for difficult pancreatic duct stones: a systematic review and meta-analysis. Endosc Int Open 2020; 8: E1460-E1470
    Thieme ConnectPubMedSearch in Google Scholar
  • 15 Manes G, Paspatis G, Aabakken L. et al. Endoscopic management of common bile duct stones: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy 2019; 51: 472-491
    Thieme ConnectPubMedSearch in Google Scholar
  • 16 Minami H, Mukai S, Sofuni A. et al. Clinical outcomes of digital cholangioscopy-guided procedures for the diagnosis of biliary strictures and treatment of difficult bile duct stones: a single-center large cohort study. J Clin Med 2021; 10: 1638
    CrossrefPubMedSearch in Google Scholar
  • 17 Sethi A, Chen YK, Austin GL. et al. ERCP with cholangiopancreatoscopy may be associated with higher rates of complications than ERCP alone: a single-center experience. Gastrointest Endosc 2011; 73: 251-256
    CrossrefPubMedSearch in Google Scholar
  • 18 Thosani N, Zubarik RS, Kochar R. et al. Prospective evaluation of bacteremia rates and infectious complications among patients undergoing single-operator choledochoscopy during ERCP. Endoscopy 2016; 48: 424-431
    Thieme ConnectPubMedSearch in Google Scholar
  • 19 Othman MO, Guerrero R, Elhanafi S. et al. A prospective study of the risk of bacteremia in directed cholangioscopic examination of the common bile duct. Gastrointest Endosc 2016; 83: 151-157
    CrossrefPubMedSearch in Google Scholar