Utility of the Novel SpyGlassTM DS II System and Laser Lithotripsy for Choledocholithiasis in Pregnancy

<b><i>Background and Aim:</i></b> Endoscopic retrograde cholangiopancreatography (ERCP) is considered a safe therapeutic modality even in pregnant women; however, adequate care needs to be taken. The utility of the SpyGlass^TM DS II system in choledocholithiasis among pregnant women is unexplored. <b><i>Methods:</i></b> We retrospectively analyzed patients who underwent<b><i></i></b>ERCP for choledocholithiasis in the absence of fluoroscopy using the SpyGlass DS II system from October 2019 to November 2020. Depending on the size and location of the stones, we used laser lithotripsy (LL) for large impacted stones, the balloon extraction technique for multiple stones, and the SpyGlass retrieval basket for single solitary stones. <b><i>Results:</i></b> A total of 10 (100% female) patients with a mean (±SD) age of 29.5 (±2.5) years underwent ERCP. Abdominal pain was the commonest presenting symptom in all patients. Four (40%) patients had cholangitis and 3 (30%) had pancreatitis. The majority of the patients (9; 90%) were in the second trimester. MRCP was the commonest radiological entity, used in 9 (90%) patients. ERCP was technically successful and the stones were removed from all of the patients in a mean (±SD) time of 30 (±3.5) min. LL was used successfully in 4 (40%) patients, balloon extraction in 3 (30%) patients, and the SpyGlass retrieval basket in 3 (30%) patients. There were no pre- or post-procedural complications. All of the patients had an uneventful childbirth, after which they underwent cholecystectomy and subsequent stent removal 2 weeks later. <b><i>Conclusions:</i></b> Use of the SpyGlass DS II system and LL during ERCP appears safe and effective for the treatment of choledocholithiasis among pregnant women.

Resección endoscópica bajo visión coledocoscópica de pólipo biliar. Reporte de un caso

Inflammatory pseudotumors of the biliary tract represent an infrequent biliary pathology, with few cases reported in literature. In radiological or surgical explorations, these tumors are usually diagnosed as unsuspected findings. They represent a challenge in preoperative diagnosis, due to the cost of specific technology such as Spyglass DS (Boston Scientific) and the need of trained personnel for its correct use. This means that most patients are usually treated with major resections with wrong preoperative diagnosis of cholangiocarcinoma, missing a chance of an endoscopic solution while adding unnecessary morbidity and mortality in benign pathology. We present a case that underwent endoscopic resection by ERCP under direct choledochoscopic view for Kehr’s biliary fístula in the General Surgery Department of a central hospital.

Digital single-operator cholangioscopy for endoscopic retrograde appendicitis therapy (ERAT)

Objective: To investigate the diagnostic and therapeutic value of the SpyGlass DS (single-operator cholangioscopy system) for endoscopic management of acute appendicitis. Methods: Fourteen patients with acute uncomplicated simple or supportive appendicitis were evaluated between November 2018 and September 2020. The diagnosis of acute appendicitis was confirmed by colonoscopy direct vision imaging and Spyglass imaging. The successful rate of the Spy-Glass DS assisted endoscopic retrograde appendicitis therapy, the procedure time, post-operative length of hospital stay, complications, and recurrence rate were recorded Results: The procedure technical success rate was 100% with high quality imaging of the appendiceal cavity of all 14 patients using SpyGlass DS. The average procedure time was 37.8 ± 22 min. Abdominal pain was relieved immediately after the procedure in all patients. The average post-operative hospital was 1.9 ± 0.7 days. No recurrence occurred during 2 to 24 months of follow-up. Conclusion: Spyglass-assisted endoscopic retrograde appendicitis therapy provides a feasible, safe, effective alternative approach to diagnose and management of acute uncomplicated appendicitis without the need for X-ray or ultrasonic guidance.

Efficacy and Safety of Digital Single-Operator Cholangioscopy in the Diagnosis of Indeterminate Biliary Strictures by Targeted Biopsies: A Systematic Review and Meta-Analysis

Background: Biliary strictures are frequently encountered in clinical practice. The determination of their nature is often difficult. This study aims to systematically evaluate the efficacy and safety of the second generation of digital single-operator cholangioscopy (SpyGlass DS, DSOC) in indeterminate biliary strictures (IBDS) through biopsies. Methods: All relative studies published in Medline, the Cochrane Library, Web of Science, and EMBASE were included. The diagnostic tests for IBDS were compared to the surgical histology, autopsy, or long-term clinical follow-up. The methodological quality of the included studies was evaluated by the Quality Assessment of Studies of Diagnostic Accuracy Included in Systematic Reviews (QUADAS-2). Results: A total of 11 studies, which involved 356 patients diagnosed through biopsies, were included. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio were 0.74 (95% CI: 0.67–0.80), 0.98 (95% CI: 0.95–1.00), 10.52 (95% CI: 5.45–20.32), 0.31 (95% CI: 0.23–0.41), and 65.18 (95% CI: 26.79–158.61), respectively. The area under the curve (AUC) was 0.9479, and the pooled adverse event rate was 7%. The sensitivity and specificity in the heterogeneity analysis were I2 = 48.1% and I2 = 25.4%, respectively. Conclusion: SpyGlass DS is a safe and effective technique for IBDS. However, future randomized trials are needed to determine optimal number of biopsies.