Novel application of SpyGlass™ cholangioscopy in the diagnosis and treatment of extrahepatic biliary obstruction in infants

Endoscopic retrograde cholangiopancreatography (ERCP) is a commonly utilized diagnostic and therapeutic modality for the treatment of obstructive extrahepatic biliary disease. In toddlers and infants ERCP is challenging and limited by the size of the common bile duct, reliance on fluoroscopy for bile duct cannulation, and indirect visualization of the bile duct via radiography. The SpyGlass™ cholangioscope (10 Fr, Boston Scientific) allows for direct visualization of bile duct pathology and enables targeted tissue biopsies within the bile duct. Case report: SpyGlass™ cholangioscopy was performed to diagnose, monitor, and therapeutically stent an embryonal rhabdomyosarcoma of the common bile duct in an 18-month-old girl who initially presented with jaundice. Initial ERCP brushings of the common bile duct proved non-diagnostic in this patient. Use of SpyGlass™ cholangioscopy allowed for visualization of the biliary mass and targeted biopsies, confirming embryonal rhabdomyosarcoma and defining the extent of disease in the right and left hepatic ducts. The child was treated with chemotherapy and radiation therapy with subsequent biopsies that have demonstrated no active disease. Conclusions: SpyGlass™ cholangioscopy is a valuable tool in the diagnosis and treatment of biliary obstructive lesions and can be utilized in children under the age of 2 with success.