Cholangioscopy (Spyglass)

What Is Cholangioscopy?

Cholangioscopy is a procedure where your gastroenterologist or physician wants to inspect your bile ducts more closely and see hard-to-reach areas that can’t be visualized using other diagnostics. Cholangioscopy can be both diagnostic and therapeutic, meaning that it can diagnose and treat diseases of the bile duct.

The same instrument that is use to visualize the bile ducts  can also be used to inspect the pancreas during the endoscopy, however, this procedure is called pancreatoscopy. The procedure is used in conjunction with endoscopic retrograde cholangiopancreatography (ERCP), which uses endoscopy and X-ray technology to examine the bile ducts, pancreas, liver, and gallbladder. ERCP has its limitations, and your physician may not be able to clearly visualize parts of the bile ducts.. If your physician feels the need to get a more clearer look in or obtain biopsy samples from the bile ducts, they may use ERCP and cholangioscopy combined or cholangioscopy as a standalone diagnostic.

Why Is Cholangioscopy Performed?

The primary reason cholangioscopy is performed is to evaluate biliary structures and to diagnose and remove bile stones. It is often used when ERCP is insufficient and direct visualization is necessary. In addition to its primary purposes, cholangioscopy is performed for other reasons as well. Some reasons diagnostic cholangioscopy is performed include:

• Evaluation of fungal infections, parasitic infections, and cytomegalovirus
• Biopsy (sampling of tissue for evaluation)
• Visual evaluation of eosinophilic cholangitis (disorder of the biliary tract), and other biliary issues
• Diagnosing hemobilia (bleeding in the biliary tract)
• Diagnosing cholangiocarcinoma (cancer of the bile ducts)
• Evaluating primary sclerosing cholangitis (inflammatory and stricturing disease of the bile ducts)

Cholangioscopy can also be therapeutic, which means the procedure is used to treat a condition. Some types of therapeutic cholangioscopy include:

• Photodynamic therapy for cholangiocarcinoma (cancer of the bile ducts)
• Cystic duct stent replacement
• Biliary stone extraction

When cholangiopancreatoscopy is used (inspection of the bile ducts and pancreas), it can diagnose and remove pancreatic stones, diagnose and potentially remove pancreatic duct tumors, diagnose chronic pancreatitis, and diagnose and potentially treat autoimmune pancreatitis.

How Is Cholangioscopy Performed?

The SpyGlassTM DS Direct Visualization System is a biomedical device made by Boston Scientific. It is relatively recent development to improve cholangioscopy. When SpyGlass cholangioscopy is performed, a 6,000-pixel fiber optic probe attached to a small camera is inserted using endoscopy. The probe allows your provider to visualize areas not seen with ERCP. It is an endoscopic procedure, so you will have twilight sedation and will be awake. A mouthpiece is placed in your mouth, and your physician may use local sedation to prevent gagging or choking. A single person can perform this procedure, so either your physician or gastroenterologist will insert the SpyScope (a special type of endoscope) into your mouth and down through your throat and your digestive tract. The SpyScope has a tiny camera with a fiber optic probe. Using the camera and probe, your provider is able to see bile ducts or other areas not previously seen in ERCP. Depending on the reason for your procedure, your doctor may perform cholangioscopy and ERCP concurrently.

How Do I Prepare for Cholangioscopy?

Before your procedure, you will sit down with your physician and review your current and past medical history. You should let your doctor know if you have allergies, what medications you are on, and supplements you take. You will be asked to fast for 8 to 12 hours prior to your procedure. If you are on blood thinners, it is imperative to let your physician know, as you should stop taking medications such as warfarin at a certain point before your procedure.

What Happens After Cholangioscopy?

After your procedure, you’ll be taken to a recovery room where you’ll be monitored. Be sure to have someone to drive you home. Your doctor may advise you not to eat for the next 24 hours, and then you can resume normal activity. You may experience some side effects after the procedure, such as:

• Sore throat, particularly if the endoscope was guided into the esophagus
• Abdominal cramps
• Gas
• Reactions to sedatives, such as drowsiness, nausea, and vomiting

If these side effects persist or seem severe, let your physician know right away.

Are There Any Complications After Cholangioscopy?

Cholangioscopy is a minimally invasive procedure that is relatively low risk, however, some patients can experience complications afterward. Some of these include:

• Pancreatitis (inflammation of the pancreas)
• Infection of the biliary tract (cholangitis)
• Hypotension (low blood pressure
• Abscess in the liver
• Bile duct injury
• Inflammatory syndrome
• Elevated pancreatic enzyme levels, without pancreatitis present
• Cholangitis
• Perforation of the bile duct  

If you suspect you are experiencing complications after your cholangioscopy, let your doctor know immediately so you can be evaluated.