When gastroenterologists at Baptist Medical Center in Jackson, North Mississippi Medical Center in Tupelo, Ocean Springs Hospital on the Mississippi Gulf Coast, or the VA Hospital in Jackson have patients that need to be evaluated and diagnosed for conditions such as gallstones, suspected malignancies, bile duct strictures and cystic lesions, they can perform a cholangioscopy procedure with the new SpyGlass Direct Visualization System.

 

The new technology allows doctors to diagnose and treat conditions such as obstructions and stones within the biliary tract via a miniature 6,000-pixel fiber optic probe that provides them with a direct view of the patient’s bile and pancreatic ducts, overcoming some of the visual hurdles of conventional ERCP (Endoscopic Retrograde Cholangiopancreatography) procedures.

 

“The SpyGlass System allows for improved biopsies, better visualization for examining diagnostic and therapeutic applications during endoscopic procedures, and a more dependable outlook and diagnosis,” said Ron Kotfila, MD, medical director of Baptist Medical Center’s Endoscopy Unit, and a board-certified gastroenterologist with expertise in biliary and pancreatic disease. Kotfila, along with Mikau Lee, MD, and Don Brannon, MD, are credentialed to use the SpyGlass System in Central Mississippi, where only Baptist has the technology. Stephen Amann, MD, medical director of the Center for Digestive Health LLC in Tupelo, and John Phillips, MD, perform the procedure at NMMC, the only hospital in north Mississippi with the technology.

 

“The fiberoptic probe is quite small, and it allows us to look directly into the bile duct without having to interpret an x-ray,” Amann said. “In the past, it could be difficult to determine where to obtain tissue samples. With this new system, we have optical guidance.”

 

The traditional method of conducting an ERCP, developed in 1976, requires cumbersome equipment and two endoscopists.

 

“The previous scope was a fairly thick instrument, with a second scope that was difficult to operate technically,” explained Kotfila. “The procedure was more expensive done in the traditional way, and required two doctors to control the duodenoscope and cholangioscope. With standard ERCP without cholangioscopy, as most are done today, there are visualization problems. For example, on the x-ray, you usually cannot tell the difference between benign strictures and malignant tumor-causing strictures. If the images are inconclusive, the patient may need to return to the hospital for another procedure.

 

“Also with standard ERCP, there are limitations to removing large stones. Frequently, patients with very large stones in the bile duct require open surgery for removal of the stones. The direct visualization of large stones during cholangioscopy with SpyGlass allows for other methods of lithotripsy, such as applying a laser to the stone or using a small catheter that delivers a shock wave. These methods allow for better success rates for large stone removal.”
Developed by Boston Scientific Corporation, the SpyGlass System has four basic components. A probe, inserted via a single-use catheter, can be steered in four directions to enable direct access and visualization and facilitate tissue acquisitions and stone disruption.

 

“The way the SpyGlass controls are incorporated into the duodenoscope,” Kotfila added, “makes it easy for a single doctor to operate.”

 

Like all endoscopic procedures, the SpyGlass procedure is done on an inpatient or outpatient basis under moderate sedation.

 

Using the SpyGlass System, a sole endoscopist positions the access-and-delivery catheter just below the operating channel of the duodenoscope. In this configuration, the physician controls both tip deflection wheels of the duodenoscope to stabilize both systems. The duodenoscope is positioned in front of the papilla, and a sphincterotomy is performed as necessary.

 

The SpyGlass System is then introduced into the therapeutic duodenoscope. The bile duct is cannulated, and the catheter guides the probe into the biliary tree. The catheter and probe are manipulated to the desired areas of interest within the duct for direct visualization. Also, selected ducts and branches of interest may be examined during repeated advancement and withdrawal of the system. If needed, forceps guided by the catheter are introduced and an endoscopic guided biopsy is taken. Fluoroscopy is used intermittently through the procedure to track dye injection and to follow the movements of various accessories that are applied. Still radiographs document important findings.

 

Johnny Sullivan, a 46-year-old former construction worker from Nettleton, was among the first patients in Mississippi to benefit from the new technology. Amann used the procedure to identify tumors in Sullivan’s bile duct, take a biopsy and then insert a stent to bypass the blockage. This helped optimize appropriate care for his cancer, which he was diagnosed with in June 2008.

 

Now that cholangioscopy has its own CPT code, most insurance providers cover the expense of the procedure with the SpyGlass System.