Efficacy of THRIVE and target controlled infusions for sedation in SpyGlassTM Cholangioscopy - A retrospective case series analysis

Abstract

Endoscopic retrograde cholangiopancreatography has diverse diagnostic and therapeutic applications, enabling treatment of biliopancreatic diseases. The newest advancement- SpyGlass™ cholangioscopy, allows single operator use to visually examine the biliary ducts, take biopsy samples, and treat large biliary stones by either electrohydraulic or laser lithotripsy. While this advancement is minimally invasive, it causes pain and discomfort to patients. Anesthesia helps improve tolerance, cooperation, and patient comfort with successful outcomes. Propofol delivered as a target-controlled infusion (TCI) titrated with bispectral index (BIS) monitoring with a combination of transnasal humidified rapid insufflation and ventilatory exchange (THRIVE) for oxygenation offers minimal perioperative airway manipulation, hemodynamic stability, and better recovery. SpyGlass™ cholangioscopy done with TCI propofol and THRIVE is quicker to perform, provides adequate space for the endoscopist to perform the procedure, improves turnover of cases, and better utilization of hospital resources, especially in a busy endoscopy room, away from the regular operation theater. This case series describes the anesthetic management of four patients with varied demographic and medical profiles who underwent SpyGlass™ cholangioscopy for cholelithiasis. Sedation was achieved using TCI propofol and THRIVE, titrated through BIS monitoring, alongside the interactive total intravenous anesthesia Mobile application (iTIVA) to track pharmacokinetics and effect-site concentrations. All patients remained hemodynamically stable, with preserved airway reflexes and oxygenation throughout. TCI propofol sedation with THRIVE and appropriate monitoring emerges as an optimal approach for SpyGlass cholangioscopy, offering shorter recovery, fewer airway complications, and faster turnover compared to conventional techniques.