Management of pancreaticobiliary disease using a new intra-ductal endoscope: the Texas experience.
OBJECTIVE
To evaluate a new single-operator mini-endoscope, Spyglass, for its performance, feasibility and safety in the management of pancreaticobiliary disease.


METHODS
In a multicenter retrospective analysis of patients undergoing intraductal endoscopy, we evaluated 128 patients (71 men, mean age 57.6 years). Indications were therapeutic (TX) in 72 (56%) and diagnostic (DX) in 56 (44%).


RESULTS
Peroral endoscopy was performed in 121 and percutaneous in seven. TX indications included CBD stones in 41, PD stones in six, and biliary strictures in 25. DX indications included abnormal LFT's in 15, abnormal imaging in 38 and cholangiocarcinoma staging in three. Visualization of the stone(s) was considered good in 31, fair in six, and poor in four. Advancement of the electrohydraulic lithotripsy probe was not possible in three patients and proper targeting of the lesion was partial in four patients. A holmium laser was used successfully in three patients. Ductal clearance was achieved in 37 patients after one procedure and in four patients after two procedures. Diagnosis of biliary strictures was modified in 20/29 and confirmed to be malignant in 10/23. Of the modified patients, no diagnosis was available in 17. Spyglass demonstrated malignancy in 8/17 and non-malignancy in nine. Suspected pathology by imaging studies and abnormal LFT's was modified in 43/63 (66%). Staging of cholangiocarcinoma demonstrated multicentric cholangiocarcinoma in 2/3. There was no morbidity associated with the use of Spyglass.


CONCLUSIONS
Spyglass Spyscope is a first generation, single operator miniature endoscope that can evaluate and treat various biliary and pancreatic tract diseases.
Fishman
Douglas S
DS
Texas Children's Hospital, Section of Pediatric Gastroenterology and Nutrition, Baylor College of Medicine, 6621 Fannin Street, Houston, TX 77030, United States.
Tarnasky
Paul R
PR
Patel
Sandeep N
SN
Raijman
Isaac
I
D000236:Adenoma / Q000473:pathology; D001650:Bile Duct Neoplasms / Q000175:diagnosis / Q000473:pathology; D001652:Bile Ducts / Q000473:pathology; D018281:Cholangiocarcinoma / Q000175:diagnosis / Q000473:pathology; D042883:Choledocholithiasis / Q000175:diagnosis; D016145:Endoscopy, Digestive System / Q000295:instrumentation / Q000379:methods; D005260:Female; D005705:Gallbladder Diseases / Q000175:diagnosis*; D042882:Gallstones / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010182:Pancreatic Diseases / Q000175:diagnosis*; D012189:Retrospective Studies