SpyGlass ‐Assisted Percutaneous Transhepatic Cholangioscopy for Benign and Malignant Biliary Strictures: A Retrospective Observational Study

PURPOSE: SpyGlass-assisted percutaneous transhepatic cholangioscopy is increasingly used to evaluate biliary strictures when standard endoscopic approaches are limited. This study evaluates the clinical indications, diagnostic performance, and safety of SpyGlass-assisted percutaneous transhepatic cholangioscopy with targeted forceps biopsy for biliary strictures at a tertiary centre. MATERIALS AND METHODS: A retrospective single-centre review identified all SpyGlass-assisted percutaneous transhepatic cholangioscopy procedures performed between May 2021 and January 2025 where biopsy of a biliary stricture was attempted. Demographic characteristics, clinical presentation, procedural details, histological findings, and complications were obtained from the hospital's electronic database. The primary outcome was technical and diagnostic success. Technical success required cholangioscope advancement, visualisation of the biliary tree, and attempted biopsy. Diagnostic success required a definitive histopathological diagnosis from the biopsy sample. Secondary outcomes included complication rates, length of hospital stay, and subsequent clinical outcomes. RESULTS: Among 99 total procedures, 39 involved biopsies of biliary strictures. The mean patient age was 67 years, and 66.7% were male. Cholangioscopy was used as the first-line intervention in most procedures (87.2%). Technical success was achieved in all procedures. Diagnostic success was 84.6%, identifying malignancy in 24 procedures and benign pathology in 9. Six biopsies (15.4%) were non-diagnostic due to atypical cells, crush artefact, or insufficient tissue. Two procedures demonstrated discordance, with negative or atypical biopsy results despite later confirmation of malignancy. Complications occurred in 16 procedures, most commonly Grade II, including one procedure-related death. Median hospital stay was 11 days. CONCLUSION: SpyGlass-assisted percutaneous transhepatic cholangioscopy demonstrates high technical success and strong diagnostic performance for biliary strictures.