ABSTRACT
Objective To preliminarily evaluate the application value of SpyGlass direct visualization system in the diagnosis and treatment of biliary stricture after liver transplantation. Methods Clinical data of 4 patients presenting with biliary stricture after liver transplantation who underwent SpyGlass direct visualization system examination were collected. The examination, treatment and prognosis of biliary stricture were analyzed. Results The examination results of color Doppler ultrasound, magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) in 4 patients suggested biliary anastomotic stricture with intrahepatic biliary dilatation, and 2 of them were complicated with intrahepatic biliary calculi. Repeated placement of biliary stent under ERCP yielded poor effect in 3 cases. SpyGlass direct visualization system examination hinted biliary anastomotic stricture in 4 patients, 3 cases of intrahepatic biliary dilatation, 3 cases of intrahepatic biliary calculi, 2 cases of purulent bile and 3 cases of floccules within the biliary tract, 1 case of congestion and edema of biliary tract wall and 2 cases of local epithelial necrosis and stiffness changes of intrahepatic biliary tract wall. The wire could not be inserted in 1 patient due to severe biliary anastomotic stricture. Four patients were treated with biliary stricture resection + biliary stone removal + biliary end-to-end anastomosis, biliary stricture resection + biliary-intestinal anastomosis, ERCP lithotomy + biliary metal stent implantation, and biliary metal stent implantation + percutaneous transhepatic bile duct lithotomy, respectively. Relevant symptoms were relieved without evident complications. All patients survived during the follow-up until the submission date. Conclusions Compared with traditional imaging examination, SpyGlass direct visualization system may more directly display the morphological characteristics of biliary tract wall and structural changes within biliary tract cavity, which is an effective examination tool for biliary stricture after liver transplantation. In addition, individualized treatment methods may be adopted for different biliary tract diseases, which is expected to improve clinical prognosis of patients.
ABSTRACT
To evaluate the application of laser lithotripsy under SpyGlass for difficult pancreatic duct stones. Data of patients who underwent laser lithotripsy under SpyGlass for difficult pancreatic duct stones from January 2018 to April 2020 in Shandong Provincial Third Hospital were collected. A total of 18 patients were included in the study and the number of endoscopic retrograde cholangiopancreatography (ERCP) performed on each patient was 1.5±0.7. The total operation success rate was 88.9% (16/18) and the number of SpyGlass lithotripsy was 1.3±0.4. The diameter of the stones was 13.17±3.69 mm and the number of stones was 1.70±0.74. Nine patients had stones located in the pancreatic head and 15 cases had stenosis of the proximal pancreatic duct. One case had post-ERCP pancreatitis. No bleeding, perforation or other complications occurred. The indwelling time of the pancreatic duct stent was 10.5±2.8 months, and the follow-up was 6-30 months. There was no recurrence of pancreatic duct stenosis or pancreatic duct stones. Laser lithotripsy under SpyGlass is safe and effective for difficult pancreatic duct stones.
ABSTRACT
Objective To study the diagnostic value of Spyglass visual impression and Spybite targeted biopsies for biliary strictures of unknown reasons. Methods Several Chinese and English databases were electronically searched for studies on biliary strictures diagnosed with Spyglass visual impression and Spybite targeted biopsies compared with golden standard ( pathological biopsy, autopsy and long-term clinical follow-up) . The methodological quality of the included studies was assessed according to QUADAS-2 items. The software Meta-DiSc ( version 1. 4 ) was used to conduct pooling on sensitivity, specificity, positive likelihood radio, negative likelihood radio and diagnostic odds ratio ( DOR ) . Heterogeneity test was performed and the summary receiver operating characteristic curve ( SROC ) was drawn for area under the curve ( AUC) . Results A total of 12 studies met the inclusion criteria, involving 532 patients who received Spyglass visual impression and 525 who received Spybite targeted biopsies. The combined specificity, sensitivity, positive likelihood ratio, negative likelihood ratio and DOR were 0. 90 (95％CI:0. 85-0. 94), 0. 89 (95％CI:0. 85-0. 93), 7. 12 (95％CI: 4. 36-11. 64), 0. 12 (95％CI:0. 07-0. 22)and 82. 40 (95％CI:33. 73-201. 28)for Spyglass visual impression, and 0. 98 (95％CI:0. 96-1. 00), 0. 66 (95％CI:0. 60-0. 71), 13. 29 (95％CI:6. 92-25. 53), 0. 37 (95％CI:0. 28-0. 47)and 51. 05 (95％CI:23. 58-110. 53) for Spybite targeted biopsies, respectively. The AUC on the SROC of Spyglass visual impression and Spybite targeted biopsies were 0. 9574 and 0. 9398, respectively. Conclusion Spyglass visual impression is useful for detecting malignant lesion, whereas Spybite targeted biopsies is better at confirming malignant diagnosis, which indicates combination of the two methods have good diagnostic value for indeterminate biliary strictures, but their negative results are not perfect in excluding biliary cancer.