A Unique Case of Spyglass Cholangioscopy-Associated Bacteremia

Introduction: Spyglass cholangioscopy is a minimally invasive procedure that is performed during ERCP to evaluate and treat biliary and pancreatic diseases more effectively. While it has been proven to be a valuable enhancement in the management of these conditions, the procedure does have associated adverse effects. Common complications of this procedure include pancreatitis, bleeding, perforation, and infection. The risk of bacteremia during Spyglass cholangioscopy, as with ERCP, arises from the introduction of the endoscope and other instrumentation into the biliary system, which causes bacterial translocation. We present a unique case of a 66-year-old woman who developed bacteremia one day after undergoing spyglass cholangioscopy. Case Description/Methods: A 66-year-old woman presented to the hospital with epigastric abdominal pain and nausea. Past medical history notable for esophageal adenocarcinoma status post chemotherapy, radiation, and gastric pull through and gastroesophageal reflux disease. Approximately 5 hours prior to her admission, she underwent an ERCP with cholangioscopy due to concern for biliary papillomatosis. During that procedure, sphincterotomy was performed and sludge was successfully extracted using a 9-12 mm balloon. There was no evidence of biliary papillomatosis and she was prescribed Ciprofloxacin 500 mg twice daily for 3 days following the procedure. Upon admission to the hospital, initial laboratory studies showed an elevated lipase at 695 (normal ref: 16-63) without leukocytosis. Blood cultures were collected on the day of admission and were found to be positive for Enterococcus faecium the following day. She started on IV vancomycin 1g daily and IV ampicillin-sulbactam 3g every 6 hours based on culture results and sensitivities. Abdominal pain and nausea improved significantly and was now tolerating a regular diet. She was discharged on oral amoxicillin-clavulanic acid 875-25mg for ten days. Discussion: The use of spyglass cholangioscopy has positively changed the landscape of interventional endoscopy by allowing for enhanced visualization during ERCP. Since bacteremia is a significant complication of this procedure, future studies can be performed to analyze outcomes of bacterial translocation in patients treated with antibiotics either before or after this procedure. Thus, our case demonstrates the importance of further research into approaches to mitigate the associated risk of bacteremia following spyglass cholangioscopy.