To Evaluate the Efficacy and Safety of Digital Single-Operator Cholangioscopy (DSOC) in Pancreato-Biliary Diseases—One Size Fits All!!!

Background/Aim: Diagnosis and treatment of indeterminate biliary strictures (IS) as well as difficult pancreato-biliary stones is challenging. DSOC offers the advantage of targeted tissue biopsy as well as lithotripsy guided procedures. Efficacy as well as safety of DSOC in pancreato-biliary diseases has not been well studied.

Aim: To evaluate the clinical success as well as safety in DSOC-guided procedures for strictures/stones.

Method: Between June 2016 to December 2023, patients with indications for DSOC were retrospectively analyzed using the clinical database. Patients baseline characteristics, histopathological correlation, adverse events were recorded .Patients with hilar stricture/mass were classified as group 1, biliary lithotripsy as group 2, and pancreatoscopy with lithotripsy as group 3. Clinical success was defined as complete stone clearance/diagnosis not requiring further DSOC sessions.

Results: A total of 104 patients predominantly males (71.2%), age 52.3 ± 7.9 years underwent DSOC out of which 45 patients were in group 1 (43.2%), 34 patients in group 2 (32.6%) and 25 patients in Group 3 (24%). Clinical success was seen in 94.6% in group 1, whereas 91.2 and 93% in group 2 and 3, respectively. In Group 1, 36 patients with confirmed malignancy cholangioscopy impression was malignant in 27 patients (75%), while in benign it was in 9 patients (20%). On comparison with previously negative brush cytology DSOC significantly improved diagnosis (p < 0.04). Primary sclerosing cholangitis (PSC) with CA 19.9 levels >95.6 U/mL followed by indeterminate strictures (>102 U/mL) had the highest risk of malignancy (p < 0.05). In Groups 2, the mean size of stones were 14.3 ± 2.3 mm whereas in group 3 it was 9.8 ± 2.3 mm. Total DSOC sessions required were 1.54 ± 0.6 and 1.64 ± 0.8 respectively with prior ERCP-guided stone clearance attempts (>2) seen in 42% patients. Adverse events were seen 10.6% which were self-limiting.

Conclusion: DSOC is effective as well as safe in pancreato-biliary diseases and offers diagnostic as well as therapeutic capabilities.

Publication History

Article published online:
22 April 2024