The clinical value of ERCP-guided cholangiopancreatoscopy using a single-operator system

BMC Gastroenterology

Frederik Swahn¹  Matthias Löhr²  Lars Lundell²  Marco Del Chiaro²  Marcus Reuterwall²  Urban Arnelo²  Lars Enochsson²  Magnus Konradsson²  Jeanne Lubbe² 

[1] Department of Surgery, Skåne University Hospital;Division of Surgery, CLINTEC, Karolinska Institutet, Center for Digestive Diseases, Karolinska University Hospital, Huddinge;

关键词: Per-oral;    Single-operator;    Cholangiopancreatoscopy;    Clinical value;    ERCP;    Spyglass;   

DOI  :  10.1186/s12876-019-0953-9

来源: DOAJ

【 摘 要 】

Abstract Background Single-operator, per-oral cholangiopancreatoscopy (SOPCP) enables direct biliopancreatic ductal visualization, targeted tissue sampling, and therapeutic intervention. At Karolinska University Hospital, SOPCP was introduced early and has since been extensively utilized according to a standardized protocol. We analysed the clinical value of SOPCP in the diagnosis and treatment of biliopancreatic diseases in a single high volume center. Methods All SOPCP procedures performed between March 2007 and December 2014 were retrospectively reviewed. Each procedure’s diagnostic yield and therapeutic value was evaluated using a predefined 4 grade scale; 1 - no diagnostic or therapeutic value, 2 - information gained did not impact clinical decision-making and in case of a therapeutic intervention, did not alter the clinical course of the patient, 3 - information gained had an impact on clinical decision-making and in the case of a therapeutic intervention, assisted subsequent disease management, and finally, 4 - information gained was essential and critical for clinical decision-making and in case of a therapeutic intervention, solved the clinical problem requiring no further therapeutic actions. Descriptive statistics were used to analyse results, with uni- and multivariate analyses completed to assess risk of adverse events. Results During the study period, 365 SOPCP procedures were performed. We found SOPCP of pivotal importance (grade 4) in 19% of cases, and of great clinical significance (grade 3) in 44% of cases. SOPCP did not affect clinical decision-making or alter clinical course (grade 1 and 2) in 37% of cases. Conclusion SOPCP offers direct access to the biliopancreatic ducts for both diagnostic and therapeutic purposes, adding significant clinical value in 64% of cases. Trial registration As this is a purely observational and retrospectively registered study in which the assignment of the medical intervention was not at the discretion of the investigator, it has not been registered in a registry.

【 授权许可】

Unknown