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Clinical Updates
New technology aids digestive disorder treatments
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Gastroenterologists at UCLA have a new tool that helps them better diagnose and treat people with difficult bile and pancreatic duct diseases. UCLA is one of a select group of hospitals in Southern California with the technology.
Direct view of ducts
Cholangioscopy is the use of a fiber-optic scope to examine the biliary system for the diagnosis and treatment of such conditions as stones, strictures or narrowing of the ducts, and tumors. UCLA is now using new cholangioscopic technology that offers advantages over traditional systems. The new technology uses a tiny 6,000-pixel fiber-optic cable that is inserted through a catheter into the duct. Because the cable is placed inside the duct, physicians are able to get a clear, direct view of the duct to determine the causes of the blockage or disease.
Advantages over other technology
The new direct visualization approach overcomes some of the challenges of conventional procedures. In Endoscopic Retrograde Cholangiopancreatography (ERCP), which has been used for many years, physicians insert a long, flexible, lighted tube called an endoscope through the patient’s mouth into the stomach and then into the first part of the small intestine to view the entrance to the biliary and pancreatic system. The endoscope is not able to enter the ducts themselves. X-rays are taken to help determine the best treatment. But these two-dimensional, black-and-white images offer only an indirect view of the duct and may not provide enough information for the physician to make a complete diagnosis. Tissue samples extracted during an ERCP sometimes prove inconclusive, prompting the need for further testing and additional procedures. Strictures, for instance, can be caused by a tumor either within the bile duct or compressing it from the outside. The narrowing may also result from a benign condition such as inflammation. In a traditional ERCP, the physician can see that the duct has narrowed, but often can’t determine why.
Diagnosing the cause of a stricture is easier with the direct visualization scope. The camera can enter and offer direct visualization of the duct itself, and can be steered in four directions. The probe provides clear and precise three-dimensional color images of the duct, enabling UCLA gastroenterologists to inspect the treatment area more thoroughly than they are able to with conventional X-ray images. The physicians are able to perform biopsies and study the pathology, shortening the time needed to determine the most appropriate treatment.
Once the proper therapy is decided, it can be administered immediately using this new scope system, which is designed with channels to deliver therapeutic instruments to the site. If, for instance, electrohydraulic lithotripsy is needed, the system helps physicians aim this water-jet therapy at the large stones to break them up for removal. Strictures and tumors can similarly be treated using the new system. By allowing for diagnosis and treatment in one procedure, the need for more invasive surgeries is reduced.
Beneficial for certain conditions
Physicians at UCLA have found that the new direct visualization system is especially useful to treat patients with two conditions: those with indeterminate, or unexplained strictures of the bile duct and those with very large common bile duct stones. Stone disease of the bile duct and gallbladder can affect as much as 10 to 20 percent of the population. Most general gastroenterologists in the com-munity can perform ERCP, but patients with difficult bile duct pathology are often best referred to UCLA.
Duct technology an advancement
UCLA gastroenterologists are using the new SpyGlass® Direct Visualization System to improve the diagnosis and treatment of disorders of the bile and pancreatic ducts.
“For difficult-to-treat stones or bile duct strictures, direct cholangioscopy is a valuable advancement,” says Yasser M. Bhat, M.D., director of advanced endoscopy at UCLA Medical Center, Santa Monica. “The new technology really aids us in difficult cases because we can see directly into the bile duct,” says Dr. Bhat. “Being able to actually look into the bile duct helps guide our therapy.”
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