Comparative efficacy and safety of SpyGlass percutaneous transhepatic cholangioscopy versus conventional cholangioscopy in challenging biliary access: a systematic review and meta-analysis.

Percutaneous transhepatic cholangioscopy (PTCS) is essential for managing patients with altered biliary anatomy when endoscopic retrograde cholangiopancreatography fails. This study aimed to compare the safety and efficacy of conventional PTCS (C-PTCS) with the SpyGlass PTCS (S-PTCS) system in cases of challenging biliary access. A systematic review and meta-analysis included 12 studies with 998 patients. Results indicated that S-PTCS had a significantly higher clinical success rate of 99% [confidence interval (CI): 96-100%] compared to 84% (CI: 73-95%) for C-PTCS ( P  < 0.01). Both techniques showed high technical success rates of 99% (CI: 96-100%) for S-PTCS and 98% (CI: 97-100%) for C-PTCS, with no significant difference ( P  = 0.61). Safety outcomes, such as pain, liver ischemia, hemobilia, cholangitis, and bleeding, were low and similar across both techniques. These findings highlight the superior clinical success of S-PTCS in challenging biliary access cases while maintaining comparable safety profiles with C-PTCS.