SpyGlass Cholangioscopy

Bile duct or pancreatic duct stones may not always be easy to tackle. Likewise, bile duct and pancreatic strictures can be extremely challenging to manage. Routine ERCP accessories do not work well for complicated stones and strictures. Such cases may require the use of a very fine scope (the “Baby” cholangioscope or SpyScope) inserted through the normal ERCP scope (the “Mother” scope) to access the bile duct directly under dual-endoscopy plus X-ray guidance. This single-operator procedure which requires concurrent handling of two scope systems mandates undivided attention and good hand-eye coordination. It is an extended version of the ERCP procedure with greater capability and precision in tackling larger, more complicated stones and difficult strictures.

Like ERCP, Spyglass Cholangioscopy is mostly performed with our patient in a prone position. Moderate to deep sedation in the presence of an anaesthetist ensures a smooth and comfortable procedure. Spyglass, being an extended ERCP procedure, takes an average of 60-90 minutes to complete. Special accessories including laser fiber and Spybite forceps may be used to break up large stones and collect tissue samples respectively. Depending on the clinical scenario, other equipments may be needed to complete the procedure. Plastic or metal tubes (stents) may be deployed into the ducts to ensure proper drainage.

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