Clinical Endoscopy

Treatment Using the SpyGlass Digital System in a Patient with Hepatolithiasis after a Whipple Procedure: Hirofumi Harima, Kouichi Hamabe, Fusako Hisano, Yuko Matsuzaki, Tadahiko Itoh, Kazutoshi Sanuki, Isao Sakaida; Clin Endosc 2018;51(6):596-599. Published online May 23, 2018; DOI: https://doi.org/10.5946/ce.2018.057

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An 89-year-old man was referred to our hospital for treatment of hepatolithiasis causing recurrent cholangitis. He had undergone a prior Whipple procedure. Computed tomography demonstrated left-sided hepatolithiasis. First, we conducted peroral direct cholangioscopy (PDCS) using an ultraslim endoscope. Although PDCS was successfully conducted, it was unsuccessful in removing all the stones. The stones located in the B2 segment were difficult to remove because the endoscope could not be inserted deeply into this segment due to the small size of the intrahepatic bile duct. Next, we substituted the endoscope with an upper gastrointestinal endoscope. After positioning the endoscope, the SpyGlass digital system (SPY-DS) was successfully inserted deep into the B2 segment. Upon visualizing the residual stones, we conducted SPY-DS-guided electrohydraulic lithotripsy. The stones were disintegrated and completely removed. In cases of PDCS failure, a treatment strategy using the SPY-DS can be considered for patients with hepatolithiasis after a Whipple procedure.

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Management of common bile duct stones: a comprehensive review
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Spyglass Direct Visualization System: Michel Kahaleh; Clin Endosc 2012;45(3):316-318. Published online August 22, 2012; DOI: https://doi.org/10.5946/ce.2012.45.3.316

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Although endoscopic retrograde cholangiopancreatography is considered the gold standard to manage biliary disorders, it has its own limitations. The single-operator cholangioscopy (SOC) system (Spyglass) may offer an interesting compromise for most advanced biliary endoscopists, in terms of size (10 Fr diameter) and complexity of use. SOC is a great step toward intraductal visualization and therapy but the best is yet to come.

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Highlights of Pancreatobiliary Endoscopy in International Digestive Endoscopy Network 2012: How Much Has It Advanced?: Seok Ho Dong; Clin Endosc 2012;45(3):297-298. Published online August 22, 2012; DOI: https://doi.org/10.5946/ce.2012.45.3.297

Abstract PDF PubReader ePub: The pancreatobiliary organ is composed of one of the most complicated structures and complex physiological functions among other digestive organs in our body. This is why endoscopic procedure in pancreaticobiliary system requires rather complicated techniques. In International Digestive Endoscopy Network (IDEN) 2012, many interesting pancreatobiliay endoscopy related topics were presented. Basic procedures like endoscopic papillary balloon dilation (EPBD), advanced techniques like endoscopic necrosectomy, prevention and management of post-ERCP pancreatitis, and spyglass system are reviewed in this highlight summary.

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