P234 The utility of single operator cholangioscopy (SOC) in the management of biliary disease: experience over a decade

Muhammad Saad; Abdullah Abbasi; Ray Mathew; Shyam Menon

doi:10.1136/gutjnl-2024-BSG.316

IntroductionThe ongoing development of cholangioscopic systems have transformed the management of complex biliopancreatic disease. Single operator cholangioscopy (SOC), facilitated by the Spyglass (Boston Scientific, USA) platform has become an important tool in a high-volume ERCP practice. We present our local experience of this platform for over a decade.MethodsThe Spyglass SOC platform was introduced into The Royal Wolverhampton Trust in 2013. Information on ERCP procedures between March 2013–2023 were extracted from the endoscopy database and data on those patients undergoing cholangioscopy or pancreatoscopy were reviewed, with follow up data to determine outcomes. Data was extracted on efficacy (complete duct clearance of stones at the index cholangioscopic procedure and yield of tissue sampling). 7-day readmission and 30-day mortality data was extracted, in addition to data on complications.ResultsOver a 10-year period, 286 Spyglass SOC procedures were performed on 191 patients (mean age 68 years, 60% female, 63% under General Anaesthesia), with 190 procedures (66%) for stone disease, 90 (31%) for strictures. Six patients underwent pancreatoscopy for pancreatic stones). Spyglass legacy, DS1 and DS2 platforms were used over the period by two operators. Cholangioscopy assisted electrohydraulic lithotripsy (EHL) was performed with complete duct clearance at the index procedure in 98 (73%) patients and at an interval procedure in 98% (range 1–3 procedures). Successful tissue acquisition was possible in all cases. Despite antibiotic cover in all patients, 19 patients (10.5%) were either admitted after their procedure, or readmitted in 7 days due to cholangitis, managed conservatively in all. Two patients (1%) developed pancreatitis, one patient developed a significant bleed from choledochal varices leading to deterioration and death and there were no episodes of visceral perforation.ConclusionsSOC is a safe, mature, and essential platform for pancreaticobiliary therapy. Cholangioscopy, with the use of Spy Glass Retrieval Snare, offers the advantages of rapid and predictable stent capture. SOC-LL leads to ductal clearance in a significantly higher proportion of patients than LBS, particularly when stone size exceeds diameter of the extrahepatic bile duct.

P234 The utility of single operator cholangioscopy (SOC) in the management of biliary disease: experience over a decade

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