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Infectious Complications and Safety Outcomes in Cholangioscopy: A Systematic Review and Meta-Analysis.

Shivangini Duggal¹, Akshay Sharma², Vishali Moond³

¹Department of Internal MedicineTexas Tech University Health Sciences Center El PasoEl PasoTexasUnited States.

Endoscopy International Open

|June 25, 2026

Summary

This study found that cholangioscopy has a 6.7% rate of infectious complications, including bacteremia. Antibiotic prophylaxis guidelines for this procedure remain unclear, suggesting targeted use in high-risk patients.

Keywords:

SpyGlass adverse events antibiotic prophylaxis bacteremia cholangioscopy choledocholithiasis

Related Experiment Videos

Area of Science:

Gastroenterology
Interventional Endoscopy
Infectious Disease

Background:

Single-operator cholangioscopy offers direct visualization and intervention for complex biliary diseases.
It is associated with higher infectious adverse events than standard ERCP.
Evidence for specific antibiotic prophylaxis in cholangioscopy is limited.

Purpose of the Study:

To systematically review and meta-analyze infectious complications following cholangioscopy.
To quantify rates of bacteremia, cholangitis, and pancreatitis.
To assess factors influencing these complication rates.

Main Methods:

Systematic search of major databases (PubMed, Embase, Scopus, Google Scholar, Cochrane Library) through March 2025.
Inclusion of 12 studies with 4413 cholangioscopy procedures reporting post-procedural bacteremia.
Random-effects meta-analyses to estimate pooled rates and secondary outcomes; meta-regression to assess heterogeneity.

Main Results:

The pooled bacteremia rate was 6.68% (I²=95.5%), cholangitis 4.59% (I²=60.0%), and pancreatitis 3.54% (I²=89.0%).
Technical and clinical success rates were high at 97.21% and 87.13%, respectively.
Prospective study designs were associated with higher bacteremia rates, explaining significant variance.

Conclusions:

Cholangioscopy is effective with a low rate of severe complications, but infectious events occur in 6.7% of cases.
Routine antibiotic prophylaxis is uncertain; targeted prophylaxis may benefit high-risk patients.
Further prospective studies are needed to standardize preventive strategies for cholangioscopy.