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Biliary Stone Management: SpyGlass DS Direct Visualization System

Biliary Stone Management: SpyGlass DS Direct Visualization System

20 Aug 2021 12:05 12:20
(15 mins)
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Biliary Stone Management: SpyGlass DS Direct Visualization System Endoscopic biliary stone removal is the gold standard with either basket or balloon with high success rate and low adverse event. However, 10-15% of stone is defined as difficult stone itself such as large stone (>1.2 cm), impacted stone, square-shaped stone and intrahepatic duct stones and bile duct anatomy such as peridiverticular papilla, disproportional between stone and bile duct more than 2mm, bile duct stricture and surgically altered anatomy. There are two methods to combat these situations. 1, Make stone smaller by using mechanical lithotripsy (ML), Laser or EHL lithotripsy under peroral cholangioscopy, Extracorporeal Shock Wave Lithotripsy (ESWL). 2, Make the ampullary outlet bigger by combined sphincterotomy with endoscopic papillary large balloon dilation (EPLBD). EPLBD can reduce the chance to use ML. Its limitations to use this technique are small distal bile duct, distal bile duct stricture, impact stone and large stone more than 3 cm and no space for basket opening.These candidates are suitable for Laser or EHL lithotripsy. Nowadays, Laser (holmium: YAG) or EHL lithotripsy commonly used under vision with single operator disposable cholangioscope (SpyGlass DS Direct Visualization System, Boston Scientific, USA) with high success more than 90% in single session even stone up to 3 cm. Either laser or EHL is comparable result. The technique of using laser or EHL under SpyGlass DS are 1.Under clear visualization with saline infusion, 2 keep laser or EHL probe at least 5mm from the distal end of SpyScope DS tip, 3 keep tip of laser or EHL 1-2 mm from the surface of the stone.The another benefit of SpyGlass DS Direct Visualization System is to confirm all stones clearance which is more accurate than cholangiogram.

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