Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 28, 2022; 28(20): 2201-2213
Published online May 28, 2022. doi: 10.3748/wjg.v28.i20.2201
Digital single-operator video cholangioscopy improves endoscopic management in patients with primary sclerosing cholangitis-a retrospective observational study
Arne Bokemeyer, Frank Lenze, Viorelia Stoica, Timur Selcuk Sensoy, Iyad Kabar, Hartmut Schmidt, Hansjoerg Ullerich
Arne Bokemeyer, Frank Lenze, Viorelia Stoica, Iyad Kabar, Hansjoerg Ullerich, Department of Medicine B (Gastroenterology, Hepatology, Endocrinology, Clinical Infectiology), University Hospital Muenster, Muenster 48149, Germany
Arne Bokemeyer, Timur Selcuk Sensoy, Hartmut Schmidt, Department of Gastroenterology, Hepatology and Transplant Medicine, University Hospital Essen, Essen 45147, Germany
Author contributions: Bokemeyer A and Ullerich H conceived and designed the study and performed the data analysis, literature review, and manuscript writing; Lenze F, Stoica V, Sensoy T, Kabar I and Schmidt H performed the data collection, data analysis, manuscript writing, and literature review; All the authors have read and approve the final manuscript.
Institutional review board statement: The study was approved by the Ethics Board of the Westphalian Wilhelms-University of Muenster and Medical Council of Westphalia-Lippe, Germany, No. 2017-490-f-S.
Informed consent statement: As approved by the Ethics Board, informed patient consent was not required for this study because of its retrospective design.
Conflict-of-interest statement: The authors declare no potential conflict of interests related to this study.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Arne Bokemeyer, MD, Academic Research, Doctor, Postdoc, Research Scientist, Department of Gastroenterology, Hepatology and Transplant Medicine, University Hospital Essen, Hufelandstraße 55, Essen 45147, Germany.
Received: January 2, 2022
Peer-review started: January 2, 2022
First decision: March 10, 2022
Revised: March 18, 2022
Accepted: April 20, 2022
Article in press: April 20, 2022
Published online: May 28, 2022

Patients with primary sclerosing cholangitis (PSC) are at a high risk of developing cholestatic liver disease and biliary cancer, and endoscopy is crucial for the complex management of these patients.


To clarify the utility of recently introduced digital single-operator video cholangioscopy (SOVC) for the endoscopic management of PSC patients.


In this observational study, all patients with a history of PSC and in whom digital SOVC (using the SpyGlass DS System) was performed between 2015 and 2019 were included and retrospectively analysed. Examinations were performed at a tertiary referral centre in Germany. In total, 46 SOVCs performed in 38 patients with a history of PSC were identified. The primary endpoint was the evaluation of dominant biliary strictures using digital SOVC, and the secondary endpoints were the performance of selective guidewire passage across biliary strictures and the diagnosis and treatment of biliary stone disease in PSC patients.


The 22 of 38 patients had a dominant biliary stricture (57.9%). In 4 of these 22 patients, a cholangiocellular carcinoma was diagnosed within the stricture (18.2%). Diagnostic evaluation of dominant biliary strictures using optical signs showed a sensitivity of 75% and a specificity of 94.4% to detect malignant strictures, whereas SOVC-guided biopsies to gain tissue for histopathological analysis showed a sensitivity of 50% and a specificity of 100%. In 13% of examinations, SOVC was helpful for guidewire passage across biliary strictures that could not be passed by conventional methods (technical success rate 100%). Biliary stone disease was observed in 17.4% of examinations; of these, in 37.5% of examinations, biliary stones could only be visualized by SOVC and not by standard fluoroscopy. Biliary stone treatment was successful in all cases (100%); 25% required SOVC-assisted electrohydraulic lithotripsy. Complications, such as postinterventional cholangitis and pancreatitis, occurred in 13% of examinations; however, no procedure-associated mortality occurred.


Digital SOVC is effective and safe for the endoscopic management of PSC patients and may be regularly considered an additive tool for the complex endoscopic management of these patients.

Keywords: Cholangitis, Sclerosing, Biliary tract diseases, Biliary strictures, Endoscopy, Gastrointestinal, Cholangioscopy, Digital single-operator video cholangioscopy

Core Tip: Endoscopic management of patients with primary sclerosing cholangitis (PSC) is complex; our study is the first to evaluate the utility of single-operator video cholangioscopy (SOVC) with digital imaging quality in these patients. Our data indicate that the use of digital SOVC in PSC patients substantially improves the evaluation of biliary strictures and that SOVC effectively supports interventions, such as stricture dilation and biliary stone treatment, in PSC patients; mild to moderate complications occurred in a minority of cases. Concluding digital SOVC may be effective and safe as an additive tool for the complex endoscopic management of PSC patients.