D0003 - Safety of Cholangioscopy Using Spyglass^TM in Individuals With Primary Sclerosing Cholangitis

Muhammad Salman Faisal, MD¹, Mauricio Columbus-Morales, MD¹, Omar Shamaa, MD², Cyrus Piraka, MD¹, Andrew Watson, MD¹, Robert Pompa, MD¹, Duyen Dang, MD¹, Tobias Zuchelli, MD¹, Sumit Singla, MD^2
1Henry Ford Hospital, Detroit, MI; ²Henry Ford Health System, Detroit, MI

Introduction: Primary sclerosing cholangitis (PSC) is associated with hepatobiliary complications including increased risk of cholangiocarcinoma and bile duct stones that require endoscopic therapy. Use of per-oral-cholangioscopy (POC) during ERCP can provide direct intraductal visualization and aid in diagnosis and treatment of PSC related biliary complications. However, there is little data regarding safety of this device in PSC patients.

Methods: We aimed to compare rates of complications such as infection, bleeding, pancreatitis, perforation and thirty-day mortality following ERCP with POC compared to ERCP without POC. Approval for the study obtained from Henry Ford Hospital institutional review board. Patients who were diagnosed with PSC and underwent ERCP with or without POC between 2013 and 2021 were identified using relevant diagnostic and billing codes from ProVation software. Each chart was then individually reviewed to gather data about demographics, procedural details and rate of complications.

Results: Twenty patients underwent ERCP with POC during this time periods and were compared to sixty-one patients who underwent ERCP without POC. There was no major difference in age and gender between the two groups. Similar proportion of individuals had cirrhosis and cholangiocarcinoma between the two groups. Main ERCP findings were dominant stricture in 65% of POC group compared to 55.7% without POC, stone disease in 30% POC group compared to 18% without POC, and cholangitis in 5% POC group compared to 9.8% in the other group. Overall complication rate was 10% in the POC group compared to 13.1% in the group without POC. In the POC group, one patient (5.0%) had perforation during the procedure, and another had post procedural bacteremia (5.0%). In the standard ERCP group, there were 7 (11.5%) patients who had infections, 2 (3.3%) had bleeding episodes and 1 (1.6%) patient had pancreatitis post procedure. There was no patient death within thirty days of the procedure in either group. Median total procedure time was longer in the POC group at 90 minutes, compared to 70 minutes for standard ERCP group. Total fluoroscopy time was similar between the two groups; 10.4 minutes in the POC group compared to 11.5 minutes in the standard ERCP group.

Discussion: ERCP with cholangioscopy has a similar rate of complications compared to ERCP without cholangioscopy in patients with PSC.


Disclosures:


Muhammad Salman Faisal, MD¹, Mauricio Columbus-Morales, MD¹, Omar Shamaa, MD², Cyrus Piraka, MD¹, Andrew Watson, MD¹, Robert Pompa, MD¹, Duyen Dang, MD¹, Tobias Zuchelli, MD¹, Sumit Singla, MD². D0003 - Safety of Cholangioscopy Using Spyglass^TM in Individuals With Primary Sclerosing Cholangitis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.