Published online May 28, 2022. doi: 10.3748/wjg.v28.i20.2201
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
Processing time: 144 Days and 14.3 Hours
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.
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.
To clarify the efficacy and safety of the recently introduced SOVC for the endoscopic management of patients with PSC.
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.
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.
Digital SOVC is effective and safe for the complex endoscopic management of PSC patients.
In the future, digital SOVC might be regularly considered as an additive tool for the endoscopic management of patients with PSC.