UNC Health Care
Illustration of three colorful digestive organs, including stomach, liver and intestines.

UNC Hospitals helps pioneer new imaging device for liver, gallbladder, bile duct problems

UNC Hospitals helps pioneer new imaging device for liver, gallbladder, bile duct problems

Imaging technologies such as endoscopy and colonoscopy, which provide direct video images from inside parts of the body such as the esophagus and the intestines, have revolutionized how doctors diagnose and treat medical conditions such as colon polyps and colon cancer.

But until recently, equipment and technology that allowed gastroenterologists to obtain direct images from inside a person’s bile or pancreatic ducts was very cumbersome and never became widely available. This made the diagnosis and treatment of patients with certain liver, pancreas, and bile duct problems – such as strictures, large stones and cancer – more difficult. Almost 500,000 people a year undergo a procedure called ERCP (endoscopic retrograde cholangiopancreatography) and many of these require additional testing and repeat procedures before a definitive diagnosis can made.

Now UNC Hospitals has joined a small number of hospitals nationwide that is using a new imaging device that provides direct images from inside the ducts as well as access to obtain tissue biopsies.

Now UNC Hospitals has joined a small number of hospitals nationwide that is using a new imaging device that provides direct images from inside the ducts as well as access to obtain tissue biopsies.

The device, known as the SpyGlass™ Direct Visualization System, includes a miniature 6,000 pixel fiber optic probe that provides physicians with a direct view of a patient’s ducts, overcoming some of the visual challenges of conventional ERCP procedures. The SpyGlass system also includes a 1 millimeter forceps that can be used to take tissue samples for biopsies. It can also be used in conjunction with an electrohydraulic lithotripsy device, which uses sound waves to break up stones.

“I have just started to use the Spyglass system to perform cholangioscopy and feel it will be very useful in examing patients with strictures, to help determine whether these strictures are benign or malignant. It will also be useful in patients with large bile duct stones. In these patients the SpyGlass system, used in conjunction with electrohydraulic lithotripsy, can fragment the stones into easily removable pieces,” said Dr. Lisa Gangarosa, a gastroenterologist and associate professor in the University of North Carolina at Chapel Hill School of Medicine.

As part of the traditional ERCP procedure, physicians use an endoscope – a long, flexible, lighted tube that is inserted through a patient’s mouth and directed through the stomach into the first part of the small intestine – in order to view the entrance to the biliary tract. At this point contrast is injected to visualize the appearance of the ducts via x-rays. However, these x-rays are two-dimensional black and white images that often do not provide enough information to obtain a complete diagnosis.

Samples obtained during convential ERCP using brush cytology or blind biopsy are non-diagnostic in up to 60-70 percent of cases, potentially creating the need for additional testing or repeat procedures.

Samples obtained during convential ERCP using brush cytology or blind biopsy are non-diagnostic in up to 60-70 percent of cases, potentially creating the need for additional testing or repeat procedures. Besides being inconvenient for patients having to return to the hospital, the procedure can take two or more hours and typically requires them not to eat or drink six to eight hours beforehand.

The SpyGlass System, developed by Boston Scientific Corporation, provides direct visual access into a patient’s biliary duct to improve diagnosis by helping to identify stones and strictures (obstructions). A fiber optic probe attaches to a camera head and is inserted through a single-use catheter that can be steered in four directions. This is designed to allow the user to access and inspect all four quadrants of the examination and treatment area. As a result, physicians are able to achieve an improved diagnosis for patients.

ABOUT UNC HEALTH CARE
The UNC Health Care System is a not-for-profit integrated health care system owned by the state of North Carolina and based in Chapel Hill. It exists to further the teaching mission of the University of North Carolina and to provide state-of-the-art patient care. UNC Health Care is comprised of UNC Hospitals, which is ranked among the top 50 in the nation in six specialties by U.S. News & World Report and ranked one of the country’s 41 best on the Leapfrog 2007 Top Hospitals list; the UNC School of Medicine, a nationally eminent research institution; community practices; home health and hospice services in seven central North Carolina counties; and Rex Healthcare and its provider network in Wake County. UNC Health Care also manages Chatham Hospital in Siler City.