The clinical value of ERCP-guided cholangiopancreatoscopy using a single-operator system
(2019) In BMC Gastroenterology 19(1).- 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... (More)
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.
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- author
- Reuterwall, Marcus ; Lubbe, Jeanne ; Enochsson, Lars ; Lundell, Lars ; Konradsson, Magnus ; Swahn, Frederik LU ; Del Chiaro, Marco ; Löhr, Matthias and Arnelo, Urban
- publishing date
- 2019-02-26
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Bile ducts, Cholangiopancreatoscopy, Clinical value, ERCP, Pancreatic ducts, Per-oral, Single-operator, Spyglass
- in
- BMC Gastroenterology
- volume
- 19
- issue
- 1
- article number
- 35
- publisher
- BioMed Central (BMC)
- external identifiers
-
- pmid:30808288
- scopus:85062267585
- ISSN
- 1471-230X
- DOI
- 10.1186/s12876-019-0953-9
- language
- English
- LU publication?
- no
- id
- 135c82b2-d663-4a8a-9280-a2b30ca2e65b
- date added to LUP
- 2019-03-13 11:09:02
- date last changed
- 2024-08-20 11:58:41
@article{135c82b2-d663-4a8a-9280-a2b30ca2e65b,
abstract = {{<p>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.</p>}},
author = {{Reuterwall, Marcus and Lubbe, Jeanne and Enochsson, Lars and Lundell, Lars and Konradsson, Magnus and Swahn, Frederik and Del Chiaro, Marco and Löhr, Matthias and Arnelo, Urban}},
issn = {{1471-230X}},
keywords = {{Bile ducts; Cholangiopancreatoscopy; Clinical value; ERCP; Pancreatic ducts; Per-oral; Single-operator; Spyglass}},
language = {{eng}},
month = {{02}},
number = {{1}},
publisher = {{BioMed Central (BMC)}},
series = {{BMC Gastroenterology}},
title = {{The clinical value of ERCP-guided cholangiopancreatoscopy using a single-operator system}},
url = {{http://dx.doi.org/10.1186/s12876-019-0953-9}},
doi = {{10.1186/s12876-019-0953-9}},
volume = {{19}},
year = {{2019}},
}