Date: 6/24/2008

Gastroenterologists at St. Mary Medical Center use new technique to "spy" on digestive tract

Gastroenterologists on staff at St. Mary Medical Center are among the first in Indiana to use new technology to diagnose and treat conditions such as obstructions and stones within the lower digestive tract. The technology, SpyGlass® Direct Visualization System, includes a tiny probe with camera that gives physicians a 3-D real-time view of a patient’s bile ducts. This detailed guide helps doctors to more accurately identify and eliminate stones and obstructions, reducing the need for additional testing or repeat procedures.

“We see high-definition in areas that used to be two-dimensional during a conventional ERCP procedure,” said Peter Mavrelis, M.D., gastroenterologist on staff at St. Mary Medical Center. “The SpyGlass System also gives us the unique ability to navigate or steer the probe in four directions, allowing a much more thorough assessment and accurate biopsy.”

In the past, doctors had to use their best sleuthing skills and turn detective to uncover the source of their patient’s reoccurring pain, especially if by the time of their appointment, that pain is gone. But physicians on staff at St. Mary Medical Center are using espionage in the form of new technology, called SpyGlass® Direct Visualization System, to solve the mysteries of pain that is centered deep down in the digestive system: the liver, gallbladder, pancreas, and bile duct.

Diseases and blockages of the gallbladder and biliary tract, ranging from gallstones to cancer, cause pain and affect millions of Americans each year. Almost half a million of those people annually undergo a procedure called an Endoscopic Retrograde Cholangiopancreatography (ERCP) to diagnose conditions of the gallbladder and bile ducts. Simply put, an ERCP is a technique in which a hollow tube called an endoscope passes through the mouth and stomach to the small intestine to examine and treat blockages such as stones, cysts, malignancies, etc. Retrograde refers to the injection of a dye into the bile ducts against the normal flow of secretions. Cholangiopancreatography refers to the visualization of the two areas: the pancreas and the cholangio or bile ducts.

“Before, it was like looking at an x-ray of the area and all we could see were shadows or a narrowing of tissue - we couldn’t always distinguish between cancer and a benign stricture,” said Ahmad Shughoury, M.D., gastroenterologist on staff at St. Mary Medical Center. “With the SpyGlass system, we are now able to directly visualize abnormalities in depth and detail, then target and biopsy much more accurately than ever before — from 85 to 90 percent better.”

Another advantage for the patient, according to Shughoury, is the SpyGlass use on especially large bile duct stones.

“Through conventional ERCP, we sometimes have difficulty removing extra large stones. But we can use lithotripsy with SpyGlass to fragment, then eliminate these stones and basically save the patient from having to have another procedure,” he said.

The SpyGlass procedure, like a traditional ERCP, is usually performed in an outpatient facility by a gastroenterologist. However, the SpyGlass® Direct Visualization System enables the physician to see great depth and detail in tissue, achieving an improved diagnosis, and reducing the occurrence of additional testing or repeat of the procedure. Besides the patient having to make a return trip to the hospital, the procedure can take up to two or more hours and usually requires no eating or drinking for six to eight hours to ensure the stomach and upper intestine are empty.

While there are less invasive techniques available, including computed tomography and ultrasound to help diagnose gastrointestinal diseases, these imaging studies often are not precise enough to enable physicians to make a definite diagnosis regarding specific conditions. Also, magnetic resonance cholangiopancreatography (MRCP) is an imaging technology that provides for a non-invasive exam of the biliary and pancreatic ducts, but, unlike ERCP, it cannot be used for treatment purposes.

Patients who have experienced reoccurring intermittent abdominal pain of unknown origin, weight loss and jaundice may be suffering from biliary disease. Your doctor may recommend an ERCP to investigate the source of your pain. For a physician on staff at the hospitals of Community Healthcare System, call 219-836-3477 or toll-free 1-866-836-3477.