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Experiences From the Use of PerOral Cholangio-Pancreaticoscopy As a Routine Diagnostic Work up Tool in a Tertiary Referral Center
Lars Enochsson*2,1, Lars R. Lundell2,1, Fredrik Swahn2,1, Matthias Loehr2,1, Urban Arnelo2,1
1Department of Surgery, Karolinska University Hospital, Stockholm, Sweden; 2Karolinska Institutet, CLINTEC, Stockholm, Sweden
Background:
Although there are a variety of modalities to diagnose pathology within the pancreatobiliary ductal tract the introduction of the single-operator peroral cholangio-pancreaticoscopy (SOPOC), SpyGlass Direct Visualization System has added a significant contribution to the diagnostic arsenal. At Karolinska University Hospital we have since 2007 used the system as an integrated part of the diagnostic work up programme. The aim of this paper is to describe our experiences and define its role in clinical practice
Methods
Between 2007 and 2010, 167 SOPOC examinations have been performed using the SpyGlass system. As we got more familair with the system there was a gradual increase in the number of examinations over the years (19(2007); 45(2008); 50(2009); 53(2010)). In all 28% of the patients were referred to us from other centers. In 145 (91.8%) of the examinations the complete system including the optical probe (SpyGlass) and the access and delivery catheter (SpyScope) was used. In the remaining 8.2% the SpyGlass was introduced through a sphincterotome catheter.
Results
167 examinations were completed in 161 patients. Among these were 56.3% males (mean age 58.4; range 21-87) and 43.7% females (mean age 61.5; range 23-89). There were 104 (62.3 %) examinations of the biliary, 45 (26.9%) of the pancreatic duct system and in 18 cases (10.8%) the ampullary tract. The optical quality of the examination was considered to be good in 90.8%, fair in 6.1% and inadequate in the remaining 3.1%. The overall postoperative complication rate of the ERCP examinations with SpyGlass was 13.3%. Postoperative complications, however, differed significantly depending on which tract that was investigated since postop complication rates were 12.6% in the biliary, 20.0% in the pancreatic and 0% in the ampullary region. The diagnostic gain was in the biliary system 82.7%, in the pancreatic duct system 68.9% and 100% in the ampullary region.
Conclusion
The single-operator SpyGlass Direct Visualization System offers a valuable diagnostic aid with significant gains in both the biliary as well as the pancreatic duct system. The large variation in postprocedural complication rates suggests the room for preventive measures which requires further studies.
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