Digest This - Special Edition 2008 - (Page 12)

cleveland clinic center for endoscopy First in ohio to use spyglass Diseases of the biliary system are frequently encountered in clinical practice. An examination of the bile ducts is often required for the appropriate diagnosis and management of patients with biliary diseases. over the past three decades, endoscopic retrograde cholangiography (ERC) has been the primary method of diagnosing and treating many biliary diseases. “ERC can demonstrate the anatomy of the biliary tract Dr. Mansour Parsi Cholangioscopy is a promising procedure that provides direct visualization of the biliary tree. SpyGlass® Direct Visualization System, manufactured by Boston Scientific, is a single operator peroral cholangioscope that recently became commercially available. Cleveland Clinic’s Center for Endoscopy and Pancreatobiliary Disorders was the first center in Ohio and one of the first in the country to use this new technology for diagnosis and treatment of patients with biliary disorders. Its catheter provides two dedicated irrigation channels in addition to a 1.2 mm working channel through which diagnostic and therapeutic devices can be used in the biliary ducts. The system includes a miniature 6,000-pixel fiber optic probe attached to a camera that provides physicians with a direct view of a patient’s bile ducts, overcoming some of the visual challenges of conventional endoscopic retrograde cholangiography (ERC) procedures. “This system is designed to allow direct visualization of the site of interest, such as a stricture or stone, rather than using traditional non-direct visualization techniques, like X-ray,” explains Dr. Parsi, primary investigator of the SpyGlass registry, who recently presented results of an international multicenter study at Digestive Disease Week® in San Diego in May 2008. The SpyGlass patient registry reports on clinical data from 296 patients at 15 U.S. and European medical centers who required peroral cholangioscopy (Po) for the treatment or diagnosis of biliary stones or indeterminate strictures with suspected pathology. Dr. Parsi presented results on a subset of patients that underwent Po using the SpyGlass System to determine its effectiveness in the treatment of difficult-to-remove biliary stones and assess its utility for the detection of stones missed by ERC. “The results demonstrated that peroral cholangioscopy using the SpyGlass System is safe and effective for the treatment of difficult-to-remove biliary stones,” he says. and reveal anatomical abnormalities, strictures and intraductal filling defects,” explains Mansour Parsi, MD. “However, this technique does not always differentiate the biological nature of bile duct lesions and may fail to determine their intraluminal extension. Furthermore, it is unable to provide information about biliary mucosal lesions that do not project into the biliary lumen.” For more information, email digestthis@ccf.org {12} Digest This Special Edition | 2008

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Digest This - Special Edition 2008 Table of Contents Investigations Institute Overview Innovations Staff Research

Digest This - Special Edition 2008

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