How SpyGlassTM May Impact Endoscopic Retrograde Cholangiopancreatography Practice and Patient Management

• Autor(a) principal: Pereira,Pedro
• Data de Publicação: 2018
• Outros Autores: Vilas-Boas,Filipe, Peixoto,Armando, Andrade,Patrícia, Lopes,Joanne, Macedo,Guilherme
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://scielo.pt/scielo.php?script=sci_arttext&pid=S2341-45452018000300007
• topic: Endoscopic retrograde cholangiopancreatography; Biliary stricture; Cholangioscopy; Pancreatoscopy

Introduction: Cholangiopancreatoscopy with SpyGlassTM Direct Visualization System (SGDVS) is being used in specialized centers for improving the sensitivity of endoscopic retrograde cholangiopancreatography (ERCP) in patients with indeterminate pancreatobiliary strictures (PBS). The aims of this study were to report our initial experience with SGDVS in the evaluation of indeterminate PBS, and discuss the improvements of ERCP brought by this technique in our center. Methods: The usefulness of SGDVS in patients with indeterminate PBS (defined after nondiagnostic previous ERCP with brush cytology) was evaluated in a prospective observational cohort study conducted at a single tertiary biliopancreatic unit. The accuracy of diagnosis by the SGDVS visual findings, SGDVS-guided biopsy, technical success, image quality, change in patient management after the procedure, and complication rate were assessed. Results: In our single-center cohort, there were 13 SGDVS procedures for evaluating indeterminate PBS. Technical success, defined by the ability to progress with the SpyScope to the target lesion, was achieved in all the cases. The diagnostic accuracy of visual findings (87.5%) was superior to SGDVS-guided biopsy (55%). In 11 (85%) procedures, the image quality was considered good. The procedure permitted exclusion of malignancy and avoiding surgery in 9 patients (69%). There were no complications during the procedures. However, in the post-procedure monitoring, 3 patients developed acute pan-creatitis (19%) and 2 patients developed acute cholangitis (13%). Conclusion: The SGDVS can be considered useful in the context of indeterminate PBS. The intervention is associated with high procedural success and alters clinical outcome compared to conventional approaches.