Diagnostic and Therapeutic Impact of Spyglass DS-Assisted Single-Operator Digital Cholangioscopy During ERCP

Aim: This study aimed to evaluate the technical success, diagnostic and therapeutic impact, safety profile, and long-term outcomes of SpyGlass DS-assisted single-operator digital cholangioscopy performed concomitantly with endoscopic retrograde cholangiopancreatography (ERCP).Methods: A retrospective analysis of 55 consecutive adult patients who underwent SpyGlass DS-assisted cholangioscopy during ERCP at a tertiary referral center between February 2022 and May 2024 was performed. Technical success, additional diagnostic findings, therapeutic outcomes, complications, and long-term outcomes were assessed.Results: Cholangioscopy was technically successful in 49 of 55 patients (89.1%). The most common indication was choledocholithiasis (78.2%), followed by evaluation of indeterminate biliary strictures, intraoperative/perioperative biliary assessment, and management of migrated stents. Among the 49 technically successful procedures, cholangioscopy revealed additional clinically relevant findings that altered patient management in 10 patients (20.4%). In five patients (10.2%), residual stones were detected despite negative balloon occlusion cholangiography during ERCP. In two patients (4.0%), intraductal lesions that could not be adequately characterized by fluoroscopic methods were visualized. In three patients, intraoperative or perioperative cholangioscopy contributed directly to surgical decision-making. Post-ERCP pancreatitis occurred in 5 patients (9.1%), all mild. During a mean follow-up of 30 months, 4 patients (7.3%) required repeat biliary intervention.Conclusions: SpyGlass DS-assisted digital cholangioscopy is a valuable adjunct to conventional ERCP, providing a high technical success rate and clinically meaningful diagnostic information beyond that obtained with standard imaging. Its ability to detect residual stones and characterize intraductal lesions may influence patient management, while selected intraoperative applications suggest a promising role in hepatobiliary surgery.