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Looking through the Spyglass

Using SpyGlass technology to locate and diagnose a gallstone. Image courtesy of Boston Scientific.
Gallstones, like kidney stones, are small, pebble-like substances capable of causing excruciating pain.

They develop in the gallbladder and can eventually block the bile ducts, causing damage or infection in the gallbladder, liver or pancreas.

Left untreated, the condition can be fatal.

Evaluating and diagnosing these problematic little stones, plus an array of other lesions and suspicious tissues in the biliary ducts and pancreas, require a procedure called endoscopic retrograde cholangiopan-
creatography or ERCP. To perform ERCP, a gastroenterologist guides a flexible endoscope through a patient’s mouth and down into the stomach. Injecting dye into the bile duct and watching continuous X-rays to see where the blockage is, the doctor can insert tools through the endoscope to remove a gallstone or tumor.

In 2002, Sacred Heart Medical Center purchased new technology that would move the X-ray camera around the patient (whereas previously, the patient had to be repositioned a number of times) and provided instant 3-D images.

At the time, Klaus Gottlieb, MD, Spokane’s only fellowship-trained specialist to do ERCP, said he felt comfortable ldquo;taking on the most difficult cases” with this technology at his side.

Six years later, Dr. Gottlieb and five other Spokane gastroenterologists are excited to see yet another revolution in ERCP.

With standard ERCP, it was not possible to directly inspect the bile duct; instead, physicians had to rely on black and white outline images created by the X-ray dye. With the new SpyGlass™ Direct Visualization System, technically known as cholangioscopy, the bile duct is directly visualized, which Dr. Gottlieb says “helps to answer a lot of difficult questions.”

The technology was made possible by a gift of $47,455 from the Sacred Heart Foundation. It has other appealing features for the physician performing the procedure, including miniature probes with improved optical resolution, better maneuverability, dedicated irrigation channels and miniature accessories like biopsy forceps. Dr. Gottlieb, who has experience with previous versions of cholangioscopy systems mainly used in Europe, says the biggest advantage of SpyGlass is that it can be controlled by just one operator.

Klaus Gottlieb, MD(pictured right) performs ERCP with Spyglass technologyComing Spring, 2008
The next addition to the services available in concert with SpyGlass is lithotripsy, most commonly used to destroy difficult kidney stones. Using the Holmium laser along with SpyGlass, lithotripsy can be used to destroy bile duct stones that otherwise would require surgery.

Pictured: Klaus Gottlieb, MD, (right) performs ERCP with SpyGlass technology.

With the SpyGlass system, a camera attached to a miniature fiber optic probe is inserted through a catheter that can be steered in four directions to access and inspect all four quadrants of the treatment area. During research trials evaluating the outcomes of the SpyGlass, investigators reported that the direct views available altered the diagnosis or treatment strategy for most patients who had previously undergone standard ERCP.

“Cholangioscopy presents significant advantages to patients, especially those suspected to have bile duct cancer and those with bile duct stones that are difficult to treat,” Dr. Gottlieb explains. “The need to refer patients to Seattle for specialized biliary interventions will decrease—no doubt.”

Other physicians with a special interest in cholangioscopy include Drs. Zdenek Bocek and Michael Brophy from
Rockwood Clinic and Drs. Steve Goodell and Michael Kestell from Spokane Digestive Disease Center.


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