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
Research background

Patients with primary sclerosing cholangitis (PSC) have a high risk of developing cholestatic liver disease, biliary strictures, and biliary cancer, which frequently require endoscopy for diagnostic and therapeutic management.

Research motivation

Recently, digital single-operator video cholangioscopy (SOVC) was introduced, offering superior image quality and manoeuvrability. However, no study thus far has reported the use of newly introduced digital SOVC in PSC patients.

Research objectives

To clarify the efficacy and safety of the recently introduced SOVC for the endoscopic management of patients with PSC.

Research methods

This observational study retrospectively included all patients with a known PSC and in whom digital SOVC (with the SpyGlass DS System) was performed between 2015 and 2019 at a tertiary referral centre. In total, 46 SOVCs performed in 38 patients with PSC were identified. The primary endpoint was the evaluation of dominant biliary strictures using digital SOVC.

Research results

The 22 of 38 patients had a dominant biliary stricture (57.9%), and in 18.2% of these cases, a cholangiocellular carcinoma was diagnosed within the stricture. Diagnostic evaluation of dominant biliary strictures using optical signs showed a sensitivity of 75% and a specificity of 94.4% in detecting malignant strictures, whereas SOVC-guided biopsies to obtain 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%) and furthermore, in 8 examinations, SOVC helped visualize and treat biliary stone disease (100% success rate). Mild to moderate complications occurred in 13% of examinations.

Research conclusions

Digital SOVC is effective and safe for the complex endoscopic management of PSC patients.

Research perspectives

In the future, digital SOVC might be regularly considered as an additive tool for the endoscopic management of patients with PSC.