Acuña-Macouzet A, Acuña-Prats R, Larracilla-Salazar I, Hernández-Pérez R, Vázquez-Zarate E, Bernal-Méndez R, Torres-Ruíz M, Torres-Méndez R

Language: Spanish
References: 20
Page: 128-134
PDF size: 235.86 Kb.

ABSTRACT

Introduction: Cholangioscopy has proven to be useful in the diagnosis and treatment of benign obstructive biliary pathology such as choledocholithiasis or biliary stenosis, especially in cases of high technical difficulty, and is accompanied by low morbidity and mortality figures. Objective: To describe our initial experience with diagnostic cholangioscopy and lithotripsy in obstructive biliary pathology. Material and methods: Analysis of a series of cases with obstructive biliary pathology treated by cholangioscopy and lithotripsy, using the SpyGlass DS^® equipment from Boston Scientific, at the Naval Medical Center in Mexico City, from October 21, 2016 to December 31, 2019, registering the demographic characteristics, causes of biliary obstruction, type of lithotripsy used, resolution rate, number of sessions required, complications and mortality were registered. Results: 15 patients were treated, two (13.33%) were male patients and 13 (86.67%) female. The median age was 73 years, with an age range of 25 to 89 years. In 66.6% of the cases, it was found that the patients had undergone previous ERCP, 33.33% only one previous, 20% with two previous and 13.33% of the cases with three previous ERCP. In 33.33% of the patients, no previous ERCP was performed. Choledocholithiasis resolution was achieved in 13 of 15 patients in the first session (86.6%), a second session was required in two patients (13.3%), finally obtaining a 100% success rate. As a complication, two patients presented mild acute pancreatitis, resolving at 48 hours in both cases (13.3%). There was one case of mortality (6.6%) Conclusion: Cholangioscopy allowed to resolve choledocholithiasis in complex cases in one to two therapeutic events with a high success rate and low morbidity and mortality, being a therapeutic option for benign biliary pathology.

REFERENCES

1. Nakajima M, Akasaka Y, Yamaguchi K et al. Direct endoscopic visualization of the bile and pancreatic duct systems by peroral cholangiopancreatoscopy (PCPS). Gastrointest Endosc. 1978; 24: 141-145.

2. Ponchon T, Gagnon P, Valette PJ et al. Pulsed dye laser lithotripsy of the bile duct stones. Gastroenterology. 1991; 100: 1730-1736.

3. Chen YK, Parsi MA, Binmoeller KF et al. Single- operator cholangioscopy in patients requiring evaluation of the bile duct disease or therapy of biliary stones (with videos). Gastrointest Endosc. 2011; 74: 805-814.

4. Chen YK, Pleskow DK. SpyGlass single operator cholangiopancreatoscopy system for the diagnosis and therapy of bile-duct disorders: a clinical feasibility study (with video). Gastrointest Endosc. 2007; 65: 832-841.

5. Shah RJ, Neuhaus H, Parsi M et al. A randomized assessment of a semidisposable, digital single operator cholangioscope in a biliary tract bench model. Endosc Int Open. 2018; 6: E851-E856.

6. Parsi MA, Jang S, Sanaka M et al. Diagnostic and therapeutic cholangiopancreatoscopy: performance of a new digital cholangioscope. Gastrointest Endosc. 2014; 79: 936-942.

7. Cotton PB, Elsen GM, Aabakken L et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc. 2010; 71: 446-454.

8. Navaneethan U, Hasan MK, Lourdusamy V et al. Single operator cholangioscopy and targeted biopsies in the diagnosis of indeterminate biliary strictures: a systematic review. Gastrointest Endosc. 2015; 82: 608-614.

9. Itoi T, Sofuni A, Itokawa F et al. Peroral cholangioscopy diagnosis of biliary-tract diseases by using narrow band imaging (with video). Gastrointest Endosc. 2007; 66: 730-736.

10. Parsi MA, Stevens T, Collins J et al. Utility of a prototype peroral video cholangioscopy system with narrow-band imaging for evaluation of biliary disorders (with videos). Gastrointest Endosc. 2011; 74: 1148-1151.

11. Kim HJ, Kim MH, Lee SK et al. Tumor vessels: a valuable cholangioscopic clue of malignant biliary stricture. Gastrointest Endosc. 2000; 52: 635-638.

12. Seeholf A, Shumacher B, Neuhaus H. Prospective study of SpyGlass guided laser lithotripsy of bile duct stones after failure of conventional endoscopic techniques (abstract). Gastrointest Endosc. 2009; 69: AB261.

13. Attwell AR, Patel S, Kahaleh M et al. ERCP with per-oral pancreatoscopy-guided laser lithotripsy for calcific chronic pncreatritis: a multicenter US experience. Gastrointest Endosc. 2015; 82: 311-318.

14. Shah RJ, Raijman I, Brauer BC et al. A US multicenter first human use experience using the fully disposable, digital single operator cholangioscope (DSOCP) (abstract). Gastrointest Endosc. 2016; 83: AB 141.

15. Manta R, Frazzoni M, Conigliaro R et al. SpyGlass single-operator peroral cholangioscopy in the evaluation of indeterminate biliary lesions: a single center, prospective cohort study. Surg Endosc. 2013; 27: 1569-1572.

16. Ishida V, Itol T, Okabe Y. Can image-enhanced cholangioscopy distinguish benign from malignant lesions in the biliary duct? Best Pract Res Clin Gastroenterol. 2015; 29: 611-625.

17. Tringall A, Lemmers A, Meves V et al. Intraductal biliopancreatic imaging: European Society of Gastrointest Endoscopy (ESGE) technology review. Endoscopy. 2015; 47: 739-753.

18. Sha RJ. Innovations in intraductal endoscopy cholangioscopy and pancreatoscopy. Gastrointest Endosc Clin N Am. 2015; 25: 779-792.

19. Wright ER, Bakis G, Srinnivasan R et al. Intraprocedural tissue diagnosis during ERCP employing a new cytology preparation of forceps biopsy (Smash protocol). Am J Gastroenterol. 2011; 106: 294-299.

20. Seithi A, Doukides T, Seipal DV et al. Interobserver agreement for single operator choledocoscopy imaging; can we do better? Diagn Ther Endosc. 2014; 14: 730-731.