The clinical value of ERCP-guided cholangiopancreatoscopy using a singleoperator system

Reuterwall, Marcus ; Lubbe, Jeanne ; Enochsson, Lars ; Lundell, Lars ; Konradsson, Magnus ; Swahn, Frederik ; Del Chiaro, Marco ; Lohr, Matthias ; Arnelo, Urban (2019)

CITATION: Reuterwall, M. et al. 2019. The clinical value of ERCP-guided cholangiopancreatoscopy using a singleoperator system. BMC Gastroenterology, 19:35, doi:10.1186/s12876-019-0953-9.

The original publication is available at https://bmcgastroenterol.biomedcentral.com

Article

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.

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