January 25, 2010

Spyglass Technology improves treatment of gallstones at Rogue Valley Medical Center

The more precise the image, the more accurate the diagnosis and the more successful the treatment, health experts agree. That's why Rogue Valley Medical Center is now using Spyglass technology to extend endoscopic retrograde cholangiopancreatography (ERCP) for less invasive treatment of gallstones and more accurate diagnosis of bile duct conditions, cancers and liver problems.

Spyglass allows physicians to see direct visualization inside of a patient's liver and bile ducts to diagnose and treat disorders such as obstructions and stones within the biliary tract, said John Hanson, RVMC clinical manager, endoscopy. "No previous technology could achieve such precise imaging," he added.

Anthony Haulk, MD, a board-certified gastroenterologist with Gastroenterology Associates and on staff at RVMC, agreed. "Spyglass is the most accurate technology available today," commented Haulk, who is one of only about 100 physicians in the entire country trained to use the system. "It allows specialists like myself to view some very remote locations within the body for more precise diagnosis and more accurate treatment." Haulk added that, with Spyglass, doctors can now see live images inside the body never possible before.

Gallstones are pebble-like objects that can cause excruciating pain. They form in the gallbladder and can migrate to block bile ducts, causing damage or infection in the gallbladder, liver or pancreas. The condition can be fatal.

Evaluating and treating these problematic stones, plus an array of other lesions and suspicious tissues in the biliary ducts and pancreas, formerly required open surgery, laparoscopic surgery, or ERCP, an endoscopic procedure using x-ray and contrast dye. 

It can take weeks to recover from surgery and the x-ray procedure is limited because it creates flat, two-dimensional black and white images. This makes it difficult to obtain tissue samples and potentially leads to an inaccurate or uncertain diagnosis. In fact, up to 70 percent of diagnostic ERCPs are inconclusive, often creating the need for additional testing or repeat procedures.

But with the Spyglass system, developed by Boston Scientific Corporation, Dr. Haulk gets direct visual access into a patient's biliary duct. The Spyglass is actually a scope within the endoscope that uses a 6,000-pixel fiber optic probe to get sharp, clear images. Dr. Haulk inserts it through a catheter that is steered in four directions. This increased maneuverability allows Dr. Haulk to access and inspect almost all of the examination and treatment area, resulting in an improved diagnosis. If biopsy is necessary, the technology includes miniature biopsy forceps, called Spybite, used to capture fragments of suspicious tissue for further testing.

The Spyglass system also gives direct views of gallstones and the ability to insert a small probe against the stone to break it up with shock waves similar to removing kidney stones. It also decreases the amount of fluoroscopy used, which decreases the amount of radiation that staff and patients are exposed to, making for a much safer procedure, especially for pregnant women.

For cancer patients, Dr. Haulk can biopsy with more certainty and make a more accurate plan for treatment and chemotherapy.

"To now be able to look in all four directions and take biopsies directly at the sites that we are seeing is a tremendous advantage for us and ultimately for the patient," continued Dr. Haulk. "Direct visualization significantly improves the chances of accurately diagnosing and treating a patient in one procedure, thus achieving the full potential of ERCP."

What are Gallstones?

Peter Adesman, MD, Gastroenterology Associates, treats patients with gallstones and bile duct problems almost every day. Adesman says 90 percent of gallstones are made when the liver secretes bile that is abnormally saturated with cholesterol. The cholesterol crystallizes to form stones that migrate into the gallbladder or common bile ducts, growing like snowballs until they block an exit. This can lead to very painful gas-like symptoms, fever, and chills. Eventually, bacteria may build up behind the blockage, causing serious infection.

What Causes Gallstones?

Though anyone may develop gallstones, Adesman says a high-fat diet is a big risk factor. Gallstones are also more common in women than men, and generally they are found in people over forty. Adesman advises patients to keep their good cholesterol (HDL) levels at or above 40 for men and 50 for women, and total cholesterol below 200.