Getting closer look at gallstones

By Jeff Raymond

Published: February 9, 2008

Removing large gallstones or those found in out-of-the-way places used to require surgery.

Now it doesn't.

With the SpyGlass Direct Visualization System at Integris Baptist Medical Center, gallstone removal takes less than an hour and requires no incisions. It uses a small flexible tube with a light and video camera at the end.

The fiber-optic probe — which has 6,000 fiber bundles in its less than 1 millimeter size — is an extension of the commonly performed procedure to diagnose problems of the gastrointestinal tract.

In the procedure, a gastroenterologist inserts a scope down a patient's throat until it reaches the first part of the small intestine, called the duodenum.

At this point, size becomes all-important.

The sparkling SpyGlass tube is inserted into a larger tube and into a hole on the side of a diagnostic scope. The new technology is able to enter tiny areas such as bile ducts that larger scopes can't.

During a Jan. 16 procedure, Dr. Robert Rankin twisted knobs to torque the SpyGlass into place. When properly situated, he stepped on a pedal to send sound waves through a small wire, obliterating a gallstone — a method called lithotripsy — that was lodged in a bile duct.

The patient was home within hours.

In the past, doctors attempted to dislodge troublesome stones, which often are made of cholesterol, with tiny balloons or by enclosing them in a basket and tugging them out. Neither worked for stones that were tightly lodged or behind tight areas of the intestine, called strictures.

Finding stones was also a challenge using X-rays and injected dye.

"Oftentimes, surgery would be the only option,” Rankin said. Although the majority of his cases are gallstone-related, he has used the scope to get behind a stricture to determine a patient didn't have cancer.

The maker, Boston Scientific, chose Baptist as one of its pilot sites for the SpyGlass because of the number and quality of diagnostic procedures gastroenterologists there perform on the liver, gall bladder, bile ducts and pancreas, said Dr. Nicolas Jabbour, a liver transplant surgeon who oversees the Nazih Zuhdi Transplant Institute.

"This is a new technology that allows us to go deep into the bile duct and deep into the pancreatic duct,” he said.

Some 40 hospitals use the system, according to Integris.

Dr. Harlin Wright, one of two physicians who use the SpyGlass at Baptist, listed the advantages of the new tool: better visualization of ducts, the ability to biopsy areas of concern and the ability to locate stones to crush with lithotripsy — before, he said, doctors had to "crush blindly” to try to eliminate stones.

The SpyGlass also has the ability to insert stents and to biopsy areas of concern. Wright said the new method gives greater certainty than taking samples in the area of the potential tumor without knowing whether tumor cells are included in the scraping.

Doctors typically would take three scrapings and assume they provided a reliable means of detecting cancer.

"In the old days, we would make the diagnosis of cancer often too late to do anything,” he said. Now, he said, "You know where you're biopsying.”

Wright said he and Rankin use the SpyGlass three or four times a week. The two have more than two decades of experience performing similar diagnostic procedures, so learning the new method wasn't too difficult. The bigger issue, Wright said, was how to use the SpyGlass to its full potential.

"The problem here is how good can we be,” he said.

The technology also may be used to examine pancreatic ducts and is useful in treating complications among post-transplant patients, he said.

An estimated 445,000 diagnostic procedures each year are performed on the liver, gallbladder, bile ducts and pancreas in the United States.

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