I Spy Biliary and Pancreatic Ducts : The SpyGlass Single - Operator Peroral Cholangiopancreatoscopy System

15 INTRODUCTION T his profile summarizes the technical aspects and the preliminary literature related to the use of the SpyGlass Direct Visualization System. This novel technology provides the endoscopist with a direct intraluminal view of the biliary duct system. Consequently, lesions within the biliary tract can be biopsied under direct vision. It also allows for the application of therapeutic devices such as electrohydraulic lithotripsy (EHL) and holmium laser to fragment stones. This technology has utility when imaging limitations of conventional endoscopic retrograde cholangiopancreatography (ERCP) are encountered. It also appears to have overcome many of the limitations of earlier generation choledochoscopes. HISTORICAL PERSPECTIVE For the better part of forty years, biliary duct evaluation via cholangioscopy, in one form or another, has been in use by gastroenterologists. The techniques and technology through which this has been possible have been under significant scrutiny and constant refinement from its onset. The evolution of peroral cholangioscopy (POCS) is impressive, and has been well documented. The earliest attempts at visualizing biliary anatomy with fiberscopes were only a glimpse of what was to come. Roughly thirty years after the first intraoperative cholangioscopy, the “mother-baby” scope was introduced. Initially a lengthy procedure requiring two specially trained endoscopists, POCS cases often lasted upwards of two hours. In addition, the early scopes were large, cumbersome and fragile. Often their specially designed optical fibers would break from the movement of the duodenoscope alone. Also, the first steering apparatuses were bidirectional as opposed to the four-quadrant steering of standard endoscopes. The initial working channels were sometimes less than adequate for biopsy forceps. I Spy Biliary and Pancreatic Ducts: The SpyGlass Single-Operator Peroral Cholangiopancreatoscopy System ENDOSCOPY: OPENING NEW EYES, SERIES #1