Direct Digital Cholangioscopy in a Patient with Primary Sclerosing Cholangitis and Hepatolithiasis: Clinical Case

Introduction. Primary sclerosing cholangitis (PSC) is a chronic progressive disease of the liver and biliary tract characterized by inflammation and fibrosis of the bile ducts, leading to multifocal strictures, impaired bile flow, cholestasis, and ultimately hepatolithiasis. One therapeutic option for this complication is endoscopic retrograde cholangiopancreatography (ERCP) with direct visualization using the SpyGlass DS system.

Materials and methods. This article describes a clinical case of a PSC progressing to liver cirrhosis and complicated by hepatolithiasis and choledocholithiasis. The clinical course was further aggravated by concomitant ulcerative colitis.

Results and discussion. A staged approach, including endoscopic retrograde papillotomy, cholangiopancreatography, and direct cholangioscopy using SpyGlass DS, enabled the complete removal of biliary stones and restoration of normal bile drainage.

Conclusion. The combined use of endoscopic retrograde papillotomy, cholangiopancreatography, and direct cholangioscopy with the SpyGlass DS system provides effective diagnostic and therapeutic management of hepatolithiasis. An individualized, multidisciplinary approach contributes to improved clinical outcomes.

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