Multicenter Assessment of Capabilities, Effectiveness and Safety of Single Operator Peroral Transpapillary Cholangiopancreaticoscopy

Aims Assessment of the capabilities of the SpyGlass system in the diagnosis and treatment of diseases of the pancreato-biliary zone. Methods From 12.2017 to 12.2020 we performed 191 single operator cholangiopancreatoscopies (SOC) in 188 patients(m-83, f-108;ranged 25-89 years;average age 57.2±32 years) using SpyGlass (Boston Scientific) in 4 leading Russianhospitals. All patient and cholangiopancreatoscopy data were recorded in the national registry. There were 164cholangioscopies and 27 pancreatoscopies. The indications for cholangioscopy were: undifferentiated strictures (97/188-51.6 %), large stones (42/188-22.3 %), “difficult strictures”, when it was impossible guidewire installation with traditionalway (15/188-8 %), postoperative benign strictures with ligatures and clips (11/188-5.8 %);for pancreaticoscopy-undifferentiated pancreatic strictures (13/188-6.9 %), morphologic verification of IPMN (3/188-1.6 %), large virsungolites(8/188-4.2 %) and assessment of the spread of major papilla adenoma on pancreatic duct (2/188-1.1 %). Results The overall technical success of SOCs was 96.3 % (184/191). Intraductal biopsy was successful in 85/87-97.7 %cases. Cholangiocarcinoma was obtained in 52(61.2 %) cases, benign strictures-in others. Therapeutic interventions weresuccessful in 64/70-91.4 % cases (laser lithotripsy of bile duct stones-14/15, electrohydraulic lithotripsy of bile ductstones-14/15 and of pancreatic duct stones-4/7, guidewire placement under visual control and further stenting-22/22,removal of ligatures(7) and clips(4) of bile duct-11/11). We had 7(3.8 %) complications-acute pancreatitis(3),bleeding(1) and cholangitis(3). Lethal outcomes after retrograde interventions not directly related to the SOC itself occurredin 2(1.1 %) patients at 5(ongoing pancreatic necrosis) and 3 day(multiple organ failure associated with COVID-19) afterERCP. Conclusions The opportunity of widespread use of SOC system in daily work for direct endoscopic examination of ductalsystems and performing invasive interventions under direct visual control provides new opportunities for increasing thelevel of diagnosis and the effectiveness of therapeutic interventions up to 96.3 %, without increasing the number of side effects during retrograde interventions.