Spyglass Cholangioscopy - Procedure Indications & Cost

During Spyglass Cholangioscopy Procedure

• Clothing, jewellery, and other objects that could obstruct the process should be removed, and the patient will be provided with a surgical gown to wear.
• Experienced therapeutic gastroendoscopists or interventional gastroenterologists performed this procedure under conscious sedation. 
• A side-viewing video duodenoscope was used to do the ERCP procedure to identify abnormalities in the biliary system. 
• The patient will be positioned prone on an x-ray table.
• The patient will be administered prophylactic antibiotics if clinically indicated.
• The interventional gastroenterologist might administer strong sedatives during the procedure, but general anaesthesia may be prescribed if clinically necessary. 
• A small mouthguard will be placed inside the patient's mouth to prevent accidental bites.
• The interventional gastroenterologist will insert the standard therapeutic duodenoscope(ERCP scope) through the mouth, slowly extend it to the stomach through the oesophagus, and reach near the ampulla of Vater or major duodenal papilla (a small opening that connects the common bile duct and pancreatic duct).
• Standard ERCP procedures are used to cannulate the duct of interest. The interventional gastroenterologist might perform a sphincterotomy to improve access to the intended ductal system and to permit duct drainage during irrigation.
• The SpyScope cholangioscope is advanced through the duodenoscope's channel and into the pancreatic or biliary ductal system to provide access for direct visualisation by repeatedly moving the SpyScope forth and backwards with the help of the four-way tip deflection.

Spyglass-guided lithotripsy procedure steps

• The spyscope catheter and optical probe will be inserted into the duodenoscope together and advanced through the papilla of Vater for direct visualisation of biliary ducts. The spyglass will be inserted until it reaches the most distal common bile duct stone (as noted before).
• If a suspicious lesion in the biliary ducts is discovered, the spybite forceps are inserted into the working channel to take samples (2 to 6) from the targeted area.
• Once the stone is identified within a bile duct, the interventional gastroenterologist will flush water through irrigation channels to clear the debris. 
• Then water, along with debris, is sucked through the therapeutic channel, which is manually drained out with the help of a syringe attached (outside, the other end) to the spyglass cholangioscope. Based on the type of lithotripsy procedures used, two types of probes can be introduced through the working channel of a spyglass. 
• An EHL (Electrohydraulic lithotripsy) probe with the tip positioned directly towards the stone will be introduced through the working channel of the Spyglass cholangioscope. The interventional gastroenterologist may release water through the irrigation channels, and shockwaves are generated by releasing an electric spark (50-90W) at the end of the probe to achieve stone fragmentation under visual guidance. Fragmented stones will be flushed into the intestinal lumen or removed using a balloon and/or basket.
• A laser probe will be introduced through the cholangioscope's working channel, with the tip positioned directly at the stone at a specific distance. A laser beam will be passed through the stone to break it into small bits, which are further flushed out into the intestinal lumen. 
• The lithotripsy techniques described above were designed to break the stones. If the stones were not completely removed during the first attempt, an additional attempt will be made. If the first two efforts are unsuccessful, the patient will be referred for surgery.
  

Post Spyglass Cholangioscopy Procedure

• The patient will be transferred to the recovery room until the sedative effect wears off while the patient's vital signs are being monitored.
• The patient might have a painful throat and find it difficult to swallow, which is quite normal, for which the gastroenterologist might prescribe medication and suggest not eating anything until the day following the procedure.
• The patient will resume a regular diet based on the dietician's guidelines and previous medication (which was stopped before the surgery).
• Based on the patient's condition, the patient might be discharged within a couple of days after the procedure.
  

Advantages of Spyglass Cholangioscopy technique

In comparison to other standard method, the following are the advantages of the spyglass cholangioscopy procedure:

• It is a single-operator system
• The scope can be inserted directly into the bile or pancreatic ducts and used to visualise the pathological conditions with a higher resolution.
• It helps the gastroenterologist obtain a targeted biopsy.
• The complex or big stones can be crushed directly by EHL or laser lithotripsy techniques.
• High success rate with minimal post-surgery complications.
  

Patient questions post Spyglass Cholangioscopy Procedure

• What is the size of the stone removed?
• Is the stone completely removed?
• What are the chances of stone reformation? 
• What kind of diet should I follow post-procedure? 
• When should I visit back for a follow-up?
• When can I go back to my work?
• Whom to contact if I have any complications?