Spyglass™ Spyscope Utility in Unusual Settings: A Case Series

The Turkish journal of gastroenterology, 2020

Background/Aims: The use of cholangioscopy for the diagnosis and treatment of hepatobiliary diseases is gradually becoming more common. We aimed to review our peroral cholangioscopy interventions, using the first-generation SpyGlass Direct Visualization System (SDVS) and summarize our experience in terms of procedures and results. Materials and Methods: Forty-one patients who underwent this procedure at our Gastroenterology Clinic between February 2010 and October 2014 were included in this study. Patients were monitored for a median (IQR) of 44 (range 38-72) months. Demographic characteristics of these patients, results of the radiological and biochemical evaluation performed prior to the procedure, cholangioscopy findings together with the data relating to the procedure, histopathological diagnosis, clinical findings and results, and their effects on patient prognosis were assessed. Results: In total, 41 patients underwent 46 cholangioscopy procedures. Of them, 21 (51.2%) were male. The most frequent clinical indications for cholangioscopy was the need to further investigate indeterminate stricture (n=16; 39%) and indeterminate filling defect (n=7; 17.1%). The procedure was considered successful in 39 patients with 41 (95.1%) receiving diagnostic and 33 (80.5%) receiving therapeutic benefits. The sensitivity and specificity for SVDS-guided biopsies and brush cytology were 80% and 87.5%; 26.6% and 75%, respectively. Complications related to the procedure occurred in a total of three patients (7.3%), two with cholangitis and one with perforation of gall bladder. Conclusion: Our experience shows that cholangioscopy procedures, performed with SDVS, are clinically applicable and safe in the diagnosis and treatment of hepatobiliary diseases.

GE Portuguese journal of gastroenterology, 2018

Cholangiopancreatoscopy with SpyGlass™ Direct Visualization System (SGDVS) is being used in specialized centers for improving the sensitivity of endoscopic retrograde cholangiopancreatography (ERCP) in patients with indeterminate pancreatobiliary strictures (PBS). The aims of this study were to report our initial experience with SGDVS in the evaluation of indeterminate PBS, and discuss the improvements of ERCP brought by this technique in our center. The usefulness of SGDVS in patients with indeterminate PBS (defined after nondiagnostic previous ERCP with brush cytology) was evaluated in a prospective observational cohort study conducted at a single tertiary biliopancreatic unit. The accuracy of diagnosis by the SGDVS visual findings, SGDVS-guided biopsy, technical success, image quality, change in patient management after the procedure, and complication rate were assessed. In our single-center cohort, there were 13 SGDVS procedures for evaluating indeterminate PBS. Technical succes...

Gastrointestinal Endoscopy, 2007

Clinical implementation of cholangioscopy for direct visual examination of bile ducts, tissue sampling, and therapeutic maneuvers has been slowed by limitations in available technology. With 4-way deflected steering and dedicated irrigation channels, the single-operator SpyGlass peroral cholangiopancreatoscopy system is designed to overcome some of these limitations. To evaluate the clinical utility and safety of the SpyGlass system for diagnostic and therapeutic endoscopic procedures in bile ducts. Prospective observational clinical feasibility study. Two tertiary referral centers. Procedural success rate defined as the proportion of SpyGlass procedures in which the diagnostic or therapeutic objectives of the procedure were achieved. SpyGlass procedures were performed in 35 patients: 22 with indeterminate strictures (63%), 5 with indeterminate filling defects (14%), 5 with stones (14%), 2 with cystic lesions (6%), and 1 patient with an indication for gallbladder stent placement (3%). The rate of procedural success was 91% (95% confidence interval 77%-98%). Twenty patients underwent SpyGlass-directed biopsy, and the specimens procured from 19 patients (95%) were found adequate for histologic evaluation. The preliminary sensitivity and specificity of SpyGlass-directed biopsy to diagnose malignancy were 71% and 100%, respectively. SpyGlass-directed electrohydraulic lithotripsy succeeded in 5 of 5 patients (100%). Procedure-related complications occurred in 2 patients (6%) and resolved uneventfully. No control group was included. Follow-up for determining preliminary sensitivity and specificity was limited. SpyGlass procedures proved to be clinically feasible, provided adequate samples for histologic diagnosis, and successfully guided stone therapy. The procedures were safe and well tolerated. Prospective multicenter clinical trials of the system are underway.

Gastroenterology, 2017

respectively. Patients were started on anti-tubercular therapy for nine months. Four patients underwent surgery for intestinal obstruction while on antitubercular therapy. Twenty eight completed full therapy and improved. Conclusion: NBI-M guided biopsy improved the yield of histology for diagnosis of GITB. Endoscopic and computed tomography abdomen findings of 32 patients with GITB High definition white light endoscopic image and corresponding narrow band imaging image of a patient with colonic tuberculosis Sa2042

World Journal of Gastroenterology, 2009

AIM: To evaluate a new single-operator mini-endoscope, Spyglass®, for its performance, feasibility and safety in the management of pancreaticobiliary disease. METHODS: In a multicenter retrospective analysis of patients undergoing intraductal endoscopy, we evaluated 128 patients (71 men, mean age 57.6 years). Indications were therapeutic (TX) in 72 (56%) and diagnostic (DX) in 56 (44%). RESULTS: Peroral endoscopy was performed in 121 and percutaneous in seven. TX indications included CBD stones in 41, PD stones in six, and biliary strictures in 25. DX indications included abnormal LFT's in 15, abnormal imaging in 38 and cholangiocarcinoma staging in three. Visualization of the stone(s) was considered good in 31, fair in six, and poor in four. Advancement of the electrohydraulic lithotripsy probe was not possible in three patients and proper targeting of the lesion was partial in four patients. A holmium laser was used successfully in three patients. Ductal clearance was achieved in 37 patients after one procedure and in four patients after two procedures. Diagnosis of biliary strictures was modified in 20/29 and confirmed to be malignant in 10/23. Of the modified patients, no diagnosis was available in 17. Spyglass® demonstrated malignancy in 8/17 and non-malignancy in nine. Suspected pathology by imaging studies and abnormal LFT's was modified in 43/63 (66%). Staging of cholangiocarcinoma demonstrated multicentric cholangiocarcinoma in 2/3. There was no morbidity associated with the use of Spyglass®. CONCLUSION: Spyglass Spyscope® is a first generation, single operator miniature endoscope that can evaluate and treat various biliary and pancreatic tract diseases.

Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2005

P Pu ur rp po os se e: : To evaluate a new videolaryngoscope and assess its ability to provide laryngeal exposure and facilitate intubation. M Me et th ho od ds s: : Five centres, involving 133 operators and a total of 728 consecutive patients, participated in the evaluation of a new videolaryngoscope [GlideScope® (GS)]. Many operators had limited or no previous GS experience. We collected information about patient demographics and airway characteristics, Cormack-Lehane (C/L) views and the ease of intubation using the GS. Failure was defined as abandonment of the technique. R Re es su ul lt ts s: : Data from six patients were incomplete and were excluded. Excellent (C/L 1) or good (C/L 2) laryngeal exposure was obtained in 92% and 7% of patients respectively. In all 133 patients in whom both GS and direct laryngoscopy (DL) were performed, GS resulted in a comparable or superior view. Among the 35 patients with C/L grade 3 or 4 views by DL, the view improved to a C/L 1 view in 24 and a C/L 2 view in three patients. Intubation with the GS was successful in 96.3% of patients. The majority of the failures occurred despite a good or excellent glottic view. C Co on nc cl lu us si io on ns s: : GS laryngoscopy consistently yielded a comparable or superior glottic view compared with DL despite the limited or lack of prior experience with the device. Successful intubation was generally achieved even when DL was predicted to be moderately or considerably difficult. GS was abandoned in 3.7% of patients. This may reflect the lack of a formal protocol defining failure, limited prior experience or difficulty manipulating the endotracheal tube while viewing a monitor.

Turkish Archives of Otorhinolaryngology, 2020

European Archives of Oto-Rhino-Laryngology, 2019

Purpose To carry out a pilot study to evaluate the efficacy of a novel, drivable endoscope (the Peregrine™ Drivable ENT Scope), compared to standard rigid endoscopes in the access, visualization, and irrigation of the paranasal sinus anatomy. Methods A prospective, multi-center, feasibility study was conducted on seventeen subjects who underwent primary functional endoscopic sinus surgery and were evaluated with the drivable endoscope and standard, rigid endoscopes (0°, 30° and 70°, as applicable). A CT scan was available for image guidance, as needed. The primary efficacy endpoint was the ability to access and visualize sinonasal anatomic landmarks. Secondary endpoints included device usability, as measured by a usability questionnaire given to surgeons postoperatively; the device's ability to irrigate the sinuses and patient reports of tolerability and pain during postoperative procedures. Results The drivable endoscope success rate in visualizing all paranasal sinus anatomic landmarks was 55.6% better than the standard rigid endoscopes: 98.3% (178/181) versus 42.7% (76/178); p < 0.001. Surgeons rated scores of over 4 (on a 1-5 scale) for the usability of the drivable endoscope to enter the maxillary, frontal and sphenoid sinuses. The ability to irrigate the sinuses using the drivable endoscope was given a mean score of 4.3, and image quality was given a mean score of 3.4. The three patients evaluated postoperatively reported low pain and high tolerability scores with the drivable endoscope. Conclusions These preliminary results indicate that the drivable endoscope is effective, easy to use and highly tolerable in sinonasal endoscopy.

Journal of Pediatric Endoscopic Surgery, 2020

Purpose We present a long-term follow-up of patients who underwent VUR correction with polyacrylate polyalcohol copolymer (PPC) injection with an emphasis on UVJ obstruction and urinary tract infection. Methods During 2009-2012, 157 children (106 girls and 51 boys) with mean age of 4.8 ± 2.8 years (mean ± SD) underwent endoscopic correction of VUR using PPC. VUR was unilateral in 74 patients and bilateral in 83, comprising 240 renal reflux units (RRU). Of these, primary VUR was present in 197 RRU (82.1%) and 43 (17.9%) were complex cases. Median followup was 7 years (range 6-10 years). Average volume of PPC was 1.2 ml (range 0.6-1.8 ml) Results Reflux was corrected in 222 RRU (92.5%) after a single injection, and in 10 RRU (4.2%) after the second injection. In RRU 7 (2.9%), reflux downgraded to Grade I and II, and they were taken off antibiotic prophylaxis. One patient (0.4%) failed endoscopic correction and required ureteral reimplantation (UR). 11 (4.6%) RRU developed UVJ obstruction, of which 9 (3.8%) required UR. All patients developed obstruction between 1 and 2 years after injection. Nineteen (12.1%) patients developed low UTI, and 12 (7.6%) patients developed febrile UTI during follow-up. None of these patients demonstrated reflux recurrence. Conclusion Our data indicate that endoscopic correction utilizing PPC does not increase the risk of obstruction during long-term follow-up.

Gastrointestinal Endoscopy, 2009

Results: Out of total 84 procedures, CP failed in 7 (8.3%) cases. The reasons for failure were: equipment related 5 (71.4%), narrowed biliary duct 1, and sphincterotomy bleed 1. There was only one minor complication (1.19%; sphincterotomy-site bleed). The mean age was 64.78 years (range 18-97). Gender: F 46, and M 38 cases. Sedation type: monitored anesthesia care 78 (92.8%), 5 conscious sedation, and 1 general anesthesia. CP was used for diagnostic purpose in 62 (73.8%) and therapeutic in 22 (26.2%) cases. Therapeutic uses were: EHL (electrohydraulic lithotripsy) for stones in 20, and CP forceps for foreign body removal in 2 cases. Biliary findings/applications were (total 79 cases): 31 benign biliary stricture, 27 extrahepatic duct stone removal (size ranging from sludge to 2 cm), 10 malignant stricture, 3 removal of foreign body, 2 intrahepatic stone removal, 1 choledochol cyst, and unremarkable in 5 cases. Pancreatic findings were (total 5 cases): 3 IPMN (intraductal papillary mucinous neoplasia), 1 stone removal, and 1 stent removal. The diagnostic yield of CP forceps was obtained in 34 out of 39 cases (87.2%). Conclusion: We found peroral cholangiopancreatoscopy as a safe and effective technique with very low failure rate of 8.3% and various applications in clinical practice. Background: Current guidelines for screening and surveillance colonoscopy intervals are based on the assumption that patients have a satisfactory bowel preparation. It is unknown whether the yield on follow up examinations in patients with suboptimal bowel preparation differs from those with adequate preparation. Methods: We reviewed all adult colonoscopies that were complete to the cecum performed in 2001 at an urban university hospital. We included those patients in Abstracts