Single-operator per-oral cholangioscopy
Topic Status Complete
Single-operator per-oral cholangioscopy for the management of hepatobiliary-pancreatic disorders.
Outcome of the appraisal
Single-operator per-oral cholangioscopy (SOPOC) shows promise for the evaluation and treatment of hepato-biliary-pancreatic disorders, but the evidence is insufficient to support routine adoption. SOPOC should instead be considered for the following populations:
1. For the diagnosis of indeterminate strictures, where conventional ERCP is inconclusive or inappropriate.
2. For the therapeutic removal of difficult bile duct stones, where conventional ERCP methods are unsuccessful or inappropriate.
SOPOC improves the accuracy of visualisation and diagnosis of indeterminate biliary strictures. HTW economic analyses show that use of SOPOC for diagnosis of indeterminate biliary strictures has the potential to be cost effective following inconclusive conventional ERCP or where ERCP is inappropriate. SOPOC is also effective at clearing difficult bile duct stones and HTW economic analyses show that it has the potential to be cost saving where conventional ERCP methods are unsuccessful.
Why was this topic appraised?
Biliary tract disorders, such as bile duct stones, biliary tumours or lesions, can be challenging to access for diagnosis or therapy. This is normally achieved through endoscopic retrograde cholangio-pancreatography (ERCP) modalities, such as cytology brushing or balloon dilation but sometime these methods are unsuccessful or inappropriate.
Unlike conventional ERCP methods, single-operator per-oral cholangioscopy (SOPOC) is able to directly visualise the biliary system, collect biopsies for diagnosis and deploy laser-based stone removal.
This topic was suggested through the Welsh Health Specialised Services Committee (WHSSC). Current access to SOPOC for eligible Welsh patients is through individual patient funding requests and referral to NHS England.
Plain language summary
Health Technology Wales (HTW) assessed the use of a surgical system called single-operator per-oral cholangioscopy (SOPOC) for people with hepato-biliary-pancreatic disorders, such as bile duct stones. Operations in this part of the digestive system can be challenging as the area is difficult to access. This means that surgeons can have trouble getting a clear picture of the area as well as difficulties removing bile stones. Because of these challenges, surgeons need to use a range of different tools during surgeries and patients can sometimes need to have two or more surgeries to get accurate results. SOPOC can be used within a traditional endoscope in order to get to hard-to-reach areas and produce a clear picture, making it easier for surgeons to remove difficult to reach stones. HTW’s guidance currently supports the use of SOPOC when traditional endoscopy has been unsuccessful in either getting a clear picture and/or removing stones. There is not enough evidence at present to support using SOPOC in all endoscopy procedures, but HTW will welcome a review into this evidence once ongoing studies have been published.