Oral transpapillary cholangiopancreaticoscopy in the diagnosis and treatment of diseases of the pancreatobiliary zone

Abstract

Aim. Evaluation of the possibilities and advantages of Spy Glass system in the diagnosis and treatment of pancreato-biliary pathology. Material and Methods. From December 1, 2017 to March 1, 2020, we performed 55 interventions in 53 patients using SpyGlass DS. There were 49 cholangioscopies, 5 pancreaticoscopies and one cholangiopancreaticoscopy. The indications for cholangioscopy were: undifferentiated strictures - 36, suspicion for Mirizzi syndrome - 2, large choledocholithiasis to perform laser lithotripsy -5, guidewire placement under visual control - 6, removal of ligature after laparascopic cholecystectomy - 1; for pancreaticoscopy - strictures in CP, suspicious of malignancy; for cholangiopancreatoscopy - assessment of the spread of major papilla tumor on common bile duct and main pancreatic duct. Results. The overall technical success of the intervention was 98.2% (54/55). Intraductal biopsy was successfully performed in 28 of29 (96.6%) planned cases. Histological confirmation of the diagnosis of cholangiocarcinoma was obtained in 6 cases. In other cases, the strictures were benign. Therapeutic interventions were performed in all 4 planned cases. No complications and mortality accured. Conclusion. The main indications for endoscopic peroralintraductal interventions are various types of undifferentiated and complicated strictures of the biliary tree and pancreatic ducts, as well as the «difficult» bile and pancreatic duct stones. The technology of diagnostic and therapeutic endoscopic interventions using the SpyGlass system is relatively simple, with a level of complications and mortality comparable to traditional transpapillary interventions.