SpyGlass system offers an ERCP upgrade

Posted on 26 March 2019

Innovative new technology brings benefits for patients and doctors, and it’s available at Mediclinic Sandton for the first time.

Patients who present with pain in the bile or pancreatic ducts will need to be examined for gallstones or other blockages. Because many of these conditions cause swelling or narrowing in the affected ducts, most patients will require a closer look than that offered by MRI, and this is where ERCP comes in.

Dr Ben Jugmohan, a surgeon at Mediclinic Sandton, explains that endoscopic retrograde cholangiopancreatography (ERCP) is a specialised technique to diagnose certain conditions of the biliary and pancreatic systems.

“We usually use a long endoscope with a camera on the end,” he says. “This is traced through the mouth, into the stomach and into the first part of the large intestine, right up to the entrance of the bile and pancreatic ducts.” Using dye and X-rays, this technique allows surgeons to get a close-up view of the disorder they are dealing with – such as gallstones and pancreatitis, or tumours and cancers – and to treat them accordingly, all in a single procedure. Before, that view came in the form of two-dimensional black-and-white pictures.

Now, new technology is enhancing that picture and improving the examination and treatment experience for patients and doctors alike. The SpyGlass Direct Visualisation System offers a 6000-pixel fibre-optic probe attached to a tiny camera, rendering precise colour images that improve the accuracy of a doctor’s assessment.

Dr Jugmohan, who has used the system in his practice – the first time this has been made available at Mediclinic Sandton – says the SpyGlass operates in conjunction with the endoscopic approach. “With a traditional ERCP, we have various means of looking into the bile and pancreatic ducts, but they all give an indirect view. The SpyGlass allows us to house a second camera in the endoscope, and this goes directly into the bile duct. This gives us much more direct visualisation into the tract.”

There are two main indications for the SpyGlass procedure, says Dr Jugmohan. “Patients with indeterminate strictures of the bile ducts can benefit in a big way. If they have tightening in the tract and we are not sure if it is caused by a cancerous tumour or not, this allows us to see directly into the area, and to collect biopsies that will enable us to make a definitive diagnosis. Patients with difficult variations of stone diseases will also benefit, especially if the stones are tricky to reach or remove with standard techniques.”

For patients with stones in the bile duct, surgeons using the traditional ERCP method will insert the endoscope into the entrance of the bile duct and then resort to indirect methods, such as extraction balloons or a crushing basket, to remove or fragment the stones. “But if there are too many, or if they are too large or too difficult to reach, you need something else. Usually, this would mean surgery.”

Surgeons typically prefer not to recommend large-scale operations if they don’t have to. The SpyGlass gives doctors the option to take a minimally invasive approach to treat stones and other blockages in the bile and pancreatic tracts. “We can place the scope directly into the duct, and use a more direct method – such as a laser – to break up the stones.”

Usually, a patient who has had surgery to remove gallstones in the biliary or pancreatic systems would require a minimum of four, and a maximum of ten, days in recovery. Dr Jugmohan says after treating his patients with the SpyGlass system, they usually go home the same day and report a lot less pain.

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