Spyglass Endoscope Improves Diagnosis of Biliary and Pancreatic Diseases

A new intraductal endoscope intended for direct visualization during a cholangioscopy allows the physician to directly see the site of interest, such as a stricture, gallstones, or other areas of concern.

The Spyglass Spyscope direct visualization system is a single operator, intraductal system that allows for not only optical viewing, but also optically-guided biopsies of the biliary and pancreatic ducts, and is compatible with both electrohydraulic lithotripsy (EHL) and a holmium laser to fragment stones. The SpyGlass System includes a 6,000-pixel fiber optic probe that is introduced in the biliary anatomy through a proprietary access and delivery catheter. The probe is designed to acquire and transmit endoscopic images and conduct light into the biliary duct, offering a 70-degree field of view that permits a wide-ranging view of the anatomy. The system also includes the access and delivery catheter, a single-use, single-operator controlled device designed to provide a pathway into the biliary anatomy for diagnostic and therapeutic devices. The four-lumen catheter includes one optic channel, one 1.2 mm accessory channel, and two independent irrigation channels. The tip of the catheter has 4-way steering capabilities to help with navigation and access into all 4 biliary quadrants. The system is complemented by the SpyBite biopsy forceps, which are designed to allow the surgeon to take targeted, optically guided biopsies. The single use forceps is equipped with a jaw designed with central spike to aid in securing small tissue samples. The Spyglass Spyscope direct visualization system is a product of Boston Scientific (Natick, MA, USA).

"This new technology will likely revolutionize the way that we take care of patients with biliary and pancreatic diseases. In an era of minimally invasive surgery, Spyglass offers our physicians the ability to accurately directly assess and treat disease and our patients to receive high-level endoscopic care," said Douglas Fishman, M.D. who participated in a study that reported the experience of a group of researchers with the new endoscope. The study was published in the march 28, 2009, issue of the World Journal of Gastroenterology.

The researchers successfully used the Spyglass Spyscope in 128 patients with disorders of the bile duct, liver, and pancreas. The primary therapeutic use was biliary and pancreatic stone therapy using EHL or holmium laser lithotripsy. Clearance of stones was achieved in 37 patients after one procedure and in 4 patients after two procedures. The most important diagnostic use was that in patients with biliary strictures thought to be malignant, the diagnosis was modified in 20 out of 29 cases, and confirmed malignant in 10 out of 23 using the Spyglass system. There was no morbidity associated with the use of the Spyglass.

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