789 - Innovative Off-Label Applications of the SpyGlass Discover™ Endoscopic System in Complex Hepatopancreatobiliary and Gastrointestinal Interventions in a Tertiary Non-transplant Center

Learning Objectives: The SpyGlass Discover™ (Boston Scientific) endoscopic visualization system holds FDA approval for biliary diagnostic and therapeutic procedures. Utilizing integrated optics and working channels, we investigated its off-label applications across complex hepatopancreatobiliary and gastrointestinal interventions.

Background: A retrospective analysis examined five off-label SpyGlass Discover™ applications from 2023-2025. All procedures occurred in multidisciplinary environments combining interventional radiology, gastroenterology, and surgical expertise.

Clinical Findings/Procedure Details: 1. Anastomotic Radiofrequency Ablation Combined with Habib™ EndoHPB RFA probes, spyglass assisted ablation of benign biliary anastomotic strictures. THIS achieved significant reduction in mean anastomotic patency times: 10 weeks versus 24 weeks in historical controls, with 2-year follow-up, decreasing reliance on repeated dilations or stenting. [3 patients]

2. Endoluminal Laser Cautery for Chronic Hemobilia When angiography or cross-sectional imaging failed to localize hemobilia, SpyGlass enabled direct bleeding source identification. Precise laser fiber cauterization under visualization achieved hemostasis in patients after >30 days of ongoing hemorrhage, eliminating need for large non-selective embolization. [1 patient]

3. Navigated Gastrojejunal Tube Placement in Roux-en-Y Anatomy SpyGlass facilitated real-time endoscopic navigation through gastric pouches and jejunal limbs, enabling feeding tube placement into efferent limbs without fluoroscopic or percutaneous assistance. This approach reduced procedural duration and enhanced tube positioning stability. [3 patients]

4. Fiducial Marker Removal from Chronic Hepatic Abscess SpyGlass enabled endoscopic localization and retrieval of previously placed markers in abscess cavity through established drainage tracks using clamshell biopsy under direct visualization, avoiding surgical intervention or biliary reconstruction. [1 patient]

5. Positive Transductal Biopsy of Pancreatic Head Lesions When EUS-guided biopsy proved unfeasible, SpyGlass via direct visualization enabled successful biopsies yielding diagnostic tissue without peri- or post-procedural complications. [1 patient]

Conclusion and/or Teaching Points: Novel Application shows promise in targeted therapy and diagnostics, but larger studies are needed to validate efficacy and safety across other clinical setting