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Surgical Endoscopy
Published in: Surgical Endoscopy 5/2013

01-05-2013

SpyGlass® single-operator peroral cholangioscopy in the evaluation of indeterminate biliary lesions: a single-center, prospective, cohort study

Authors: Raffaele Manta, Marzio Frazzoni, Rita Conigliaro, Livia Maccio, Gianlugi Melotti, Emanuele Dabizzi, Helga Bertani, Mauro Manno, Danilo Castellani, Vincenzo Villanacci, Gabrio Bassotti

Published in: Surgical Endoscopy | Issue 5/2013

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Abstract

Background

SpyGlass® single-operator peroral cholangioscopy appears to be a promising technique to overcome some limitations of conventional peroral cholangioscopy. We aimed to prospectively evaluate the SpyGlass system in a cohort of patients with indeterminate biliary lesions.

Methods

Patients with indeterminate strictures or filling defects at endoscopic retrograde cholangiopancreatography (ERCP) were consecutively enrolled. After SpyGlass visual evaluation, targeted biopsies were taken with the SpyBite® and histopathological assessment was made by two experienced gastrointestinal pathologists. SpyBite-targeted biopsy results were evaluated by assessing agreement with surgical specimens and by evaluation of final, clinical follow-up-based diagnosis.

Results

Fifty-two patients participated in the study. In 7 cases, definite diagnosis (stones, varices) was made by SpyGlass endoscopic evaluation. In 42 of the remaining 45 cases, material suitable for histopathology assessment was provided by the SpyBite. Overall, a definite diagnosis was made in 49 (7 + 42; 94 %) cases. Agreement of SpyBite biopsy results with surgical specimen diagnosis was found in 38/42 (90 %) cases; sensitivity, specificity, and positive and negative predictive values were 88, 94, 96, and 85 %, respectively. Procedure-related complications consisted of one case of mild cholangitis and one case of mild pancreatitis.

Conclusions

In our series, the SpyGlass system allowed adequate biopsy sampling and definite diagnosis with high accuracy in the vast majority of patients with indeterminate biliary lesions. Its use was associated with a low complication rate. Further refinements of the technique are warranted, but the SpyGlass system has the potential to become a diagnostic standard for the assessment of indeterminate biliary lesions.
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Metadata
Title
SpyGlass® single-operator peroral cholangioscopy in the evaluation of indeterminate biliary lesions: a single-center, prospective, cohort study
Authors
Raffaele Manta
Marzio Frazzoni
Rita Conigliaro
Livia Maccio
Gianlugi Melotti
Emanuele Dabizzi
Helga Bertani
Mauro Manno
Danilo Castellani
Vincenzo Villanacci
Gabrio Bassotti
Publication date
01-05-2013
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 5/2013
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-012-2628-2

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