Authors' objectives: This report aims to identify and summarise evidence that addresses the following question: What is the clinical and cost effectiveness of single operator per-oral cholangioscopy (SOPOC) for diagnostic and therapeutic management of hepato-biliary-pancreatic disorders?

Authors' results and conclusions: 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 endoscopic retrograde cholangio-pancreatography (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.

Authors' recommendations: 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.

Authors' methods: The Evidence Appraisal Report is based on a literature search (strategy available on request) for published clinical and economic evidence on the health technology of interest. It is not a full systematic review but aims to identify the best available evidence on the health technology of interest. Researchers critically evaluate and synthesise this evidence. We include the following clinical evidence in order of priority: systematic reviews; randomised trials; non-randomised trials. We only include evidence for “lower priority” evidence where outcomes are not reported by a “higher priority” source. We also search for economic evaluations or original research that can form the basis of an assessment of costs/cost comparison. We carry out various levels of economic evaluation, according to the evidence that is available to inform this.

Project Status: Completed

Year Published: 2020

URL for published report: https://www.healthtechnology.wales/reports-guidance/spyglass-for-the-management-of-hepatobiliary-pancreatic-disorders/

English language abstract: An English language summary is available

Publication Type: Rapid Review

Country: Wales, United Kingdom

Organisation Name: Health Technology Wales

Contact Address: Floor 3, 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ

Contact Name: Susan Myles, PhD

Contact Email: healthtechnology@wales.nhs.uk

Copyright: Health Technology Wales