What Is SpyGlass Cholangioscopy?

SpyGlass cholangioscopy is a recently developed technique for the visualization of the bile ducts.

Cholangioscopy is a procedure in which a flexible tube, called an endoscope, allows the doctor to visualize the inside of the bile ducts. It is used to treat related medical conditions, such as removal of bile duct stones. 

When coupled with the visualization of the pancreas, it’s called cholangiopancreatoscopy. Your doctor may choose to perform a cholangioscopy if other imaging techniques are insufficient to make an adequate diagnosis or therapeutic intervention is needed to direct visualization. 

In addition to the visualization of the bile ducts, cholangioscopy will help your physician to visualize and examine the hepatic (liver) and pancreatic ducts.

SpyGlass cholangioscopy is a recently developed technique for the visualization of the bile ducts. It allows your doctor to see your biliary duct system and difficult-to-reach, small ducts in the pancreas, with a 6,000-pixel, fiber-optic probe attached to a tiny camera. 

The procedure can be performed by a single doctor or endoscopist. Unlike the SpyGlass system, the previously used endoscopes were fragile and difficult to use. The newer versions of the SpyScope (the endoscope used in SpyGlass cholangioscopy) provide better and easier visualization.

Before the SpyGlass cholangioscopy, your doctor may:

• Order blood tests and imaging studies
• Ask you about any chronic health conditions
• Ask you about any medications you are on
• Ask about any allergies you may have
• Explain the procedure in detail, including possible complications and address your doubts and concerns related to the procedure
• Obtain your written consent
• Ask you to not eat anything for at least eight to 12 hours before the procedure

During the cholangioscopy:

• You will be asked to wear a hospital gown.
• The anesthesiologist will give you a sedative and make your throat numb with a little local anesthetic.
• Your vital signs will be monitored during the procedure.
• A mouthpiece will be placed between your teeth to protect your mouth.
• You will not have any feeling of gagging or choking.
• The endoscope does not hinder or interfere with your breathing.

After the procedure:

• Your vital signs will be monitored in the recovery room.
• You will stay in the recovery room until you are weaned off the effect of the sedative. 
• You may be asked to not eat anything until the next day.
• Because you will be under the effect of sedatives, you will need someone to drive you home.

SpyGlass cholangioscopy may be done to diagnose and treat various conditions of the bile ducts, liver, and pancreas with the following:

• Biopsy of indeterminate strictures (abnormal narrowing of the ducts) 
• Exclusion of a cancerous stricture 
• Diagnosing cancers of the bile ducts 
• Precise preoperative location of tumors within the bile or pancreatic ducts
• Diagnosis and evaluation of post-transplantation biliary issues
• Evaluation of certain infections
• Hemobilia (bleeding from and/or into the biliary tract)

Treatment of cancers of the biliary or pancreatic ducts 

Extraction or dissolution of biliary stones

Diagnosis of chronic pancreatitis

Pancreatic stones extraction

Diagnosis of pancreatic duct tumors

Potential role in autoimmune pancreatitis

The complications of cholangioscopy are:

• Infections
• Abdominal pain
• Pancreatitis (inflammation of the pancreas)
• Hypotension (low blood pressure)
• Nausea/vomiting
• A liver abscess (collection of pus in the liver)
• Injury of the bile duct
• Nerve damage
• Elevated pancreatic enzymes (amylase and lipase) without clinical pancreatitis
• Inflammatory syndrome