SpyGlass‐Assisted Percutaneous Transhepatic Cholangioscopy in Patients With Biliary Duct Calculi: A Retrospective Cohort Study From an Australasian Centre

INTRODUCTION: Percutaneous transhepatic cholangioscopy has emerged as a viable alternative to endoscopic retrograde cholangiopancreatography for the management of biliary duct calculi. This study aimed to evaluate the outcomes of treating biliary duct calculi using SpyGlass-assisted percutaneous transhepatic cholangioscopy. METHODS: A retrospective review was conducted of all patients who underwent SpyGlass-assisted percutaneous transhepatic cholangioscopy at a single-centre between May 2021 and December 2024. Demographic, clinical, imaging, procedural, and adverse event data were collected from electronic medical records. The primary outcome was clinical success, defined as complete resolution of presenting symptoms with associated improvement in biochemical markers. The secondary outcome was technical success, defined as complete clearance of biliary duct calculi on direct visualisation using SpyGlass cholangioscopy and fluoroscopic imaging. Adverse events were recorded and classified according to severity using the Clavien-Dindo classification. RESULTS: Between May 2021 and December 2024, 27 patients underwent 42 SpyGlass-assisted percutaneous transhepatic cholangioscopy procedures for 32 distinct clinical presentations. Clinical success was achieved in all presentations, and technical success was recorded at 83% of procedures. Adverse events occurred in 36% of procedures, the majority of which were minor (Clavien-Dindo classification Grade 1 or 2). There was a single case of procedure-related mortality. CONCLUSION: SpyGlass-assisted percutaneous transhepatic cholangioscopy appears to be a safe and effective alternative for the management of biliary duct calculi, particularly in cases where endoscopic retrograde cholangiopancreatography is unsuccessful or contraindicated.