Sa1356 SPYGLASS DIGITAL SYSTEM VERSUS SPYGLASS LEGACY SYSTEM FOR PERORAL CHOLANGIOSCOPY-GUIDED LITHOTRIPSY FOR DIFFICULT BILE DUCT STONES

Although a single-operator cholangioscope (SOC) system by SpyGlass Legacy showed usefulness for diagnosis and management of biliary diseases, it has several limitations. A digital version of the single-operator cholangioscope (SpyGlass DS) is recently introduced and it provides higher-resolution imaging and ease of use compared with previous one. In this study, we compared clinical efficacy of SOC-guided lithotripsy for difficult bile duct stones between SpyGlass DS and SpyGlass Legacy. In total, 16 patients in the DS group and 18 patients in the Legacy group were retrospectively analyzed. All patients had unsuccessfully treated for bile duct stones using conventional endoscopy, including mechanical lithotripsy (ML), underwent electrohydraulic lithotripsy (EHL) or laser lithotripsy (LL) under SpyGlass DS or Legacy (Boston Scientific Corp, Marlboro, MA, USA). There was no significant difference in the size, number and location of stones between the DS and Legacy groups. Visualization of biliary stones, followed by stone fragmentation was initiated successfully in all patients. The visual quality with excellent or good was observed significantly higher in DS group than Legacy group (93.8% vs. 22.2%, P<0.001). In Legacy group, LL was performed significantly in higher number of patients than DS group (72.2% vs. 37.5%, P=0.045). The median procedure time for lithotripsy was 20.0 min and 26.0 min in DS and Legacy groups, respectively (P=0.187). The complete stone removal achieved in 15 patients (93.8%) in DS group and 17 patients (94.4%) in Legacy group (P=0.727). Although SpyGlass DS showed higher image quality than SpyGlass Legacy, clinical efficacy for SOC-guided lithotripsy over SpyGlass Legacy was not observed. Further study with large number of patients is warranted.