SpyGlass Endoscopy

SpyGlass endoscopy, also called single-operator cholangioscopy, is an endoscopic technique that lets the doctor look directly inside the bile ducts and pancreatic duct in real time.

It is used during ERCP (Endoscopic Retrograde Cholangiopancreatography). ERCP on its own shows the ducts indirectly on X-ray; cholangioscopy adds a direct view, so a biopsy can be aimed at a narrowed area and large stones can be broken up under vision.

Cholangioscopy is mainly used for bile duct narrowings whose cause is unclear, for stones too large to remove with standard ERCP, and for lesions that other tests have not explained.

The bile ducts and pancreatic ducts are narrow channels that carry bile and pancreatic juices into the intestine for digestion.

When these ducts become blocked, narrowed, or inflamed, it can lead to symptoms such as jaundice, abdominal pain, infection, or pancreatitis.

Conventional ERCP provides indirect images of these ducts using contrast dye and X-rays — but certain conditions, especially small tumors or indeterminate strictures, require direct visualization for accurate diagnosis.

That’s where SpyGlass comes in — offering clarity, precision, and therapeutic capability in a single session.

SpyGlass is performed as part of an advanced endoscopic procedure called Cholangioscopy or Pancreatoscopy.

It uses a miniature fiber-optic probe (less than 3 mm in diameter) that passes through the working channel of a standard duodenoscope during ERCP. The system includes:

• SpyScope™ Access and Delivery Catheter: A flexible channel through which the SpyGlass probe is introduced.
• SpyCam™ Digital Controller: Provides high-definition imaging on a monitor.
• SpyBite™ Forceps: Tiny biopsy forceps that can take targeted tissue samples under direct vision.
• SpyStone™ Accessories: For fragmentation and removal of complex stones.

The entire system allows 360° navigation inside the ducts and clear visualization even in narrow or curved anatomy.

• Preparation: The patient is asked to fast for several hours before the procedure. Sedation or general anesthesia is given for comfort.
• Scope Insertion: A specialized endoscope (duodenoscope) is gently advanced through the mouth into the duodenum, where the bile and pancreatic ducts open.
• Cannulation and Access: The opening (ampulla) of the bile duct is cannulated, and the SpyScope catheter is inserted.
• SpyGlass Visualization: The SpyGlass probe is introduced through the catheter, providing a real-time, magnified view inside the bile or pancreatic ducts. The endoscopist can inspect strictures, tumors, or stones directly.
• Targeted Interventions: Depending on the condition, the doctor may:
  • Take precise biopsies using SpyBite forceps for histopathology.
  • Fragment and remove stones using laser or electrohydraulic lithotripsy under direct vision.
  • Evaluate post-surgical ducts or monitor previous stent placements.
• Completion: The instruments are removed, and the patient is monitored during recovery. Most patients can go home the same day or the next morning.

Cholangioscopy is used in the diagnosis and treatment of several biliary and pancreatic conditions, including:

• Indeterminate biliary strictures: to differentiate between benign and malignant causes.
• Suspected cholangiocarcinoma: bile duct cancer.
• Complex or large bile duct stones: resistant to standard ERCP removal.
• Intrahepatic duct stones: stones located within liver bile ducts.
• Evaluation of postoperative or post-transplant bile ducts.
• Pancreatic duct strictures or small intraductal tumors.
• Monitoring after stent placement or reconstructive biliary surgery.

By allowing direct visualization and precise biopsy, SpyGlass significantly improves diagnostic accuracy and treatment success compared to conventional imaging.

• Direct visual confirmation: The doctor can see the disease site directly inside the ducts.
• Targeted biopsy: Sampling under vision improves diagnostic accuracy, reducing false negatives.
• Precise therapy: Enables laser stone fragmentation and clearance without surgery.
• Comprehensive evaluation: Identifies hidden lesions missed by traditional ERCP.
• Minimally invasive: Performed via natural openings, reducing pain and recovery time.
• Single-session solution: Diagnosis and treatment often completed in one sitting.

SpyGlass has become a cornerstone for managing complex biliary and pancreatic ductal diseases, particularly when standard ERCP or imaging is inconclusive.

After SpyGlass cholangioscopy, patients are monitored briefly as sedation wears off. Mild throat discomfort or bloating may occur temporarily.

• Most can resume normal diet and routine within 24 hours.
• The doctor discusses findings and biopsy results, which help plan further treatment if necessary (e.g., surgery, stent placement, or medication).
• Follow-up imaging may be recommended depending on the condition treated or findings obtained during the procedure.

Cholangioscopy adds a direct view inside the bile and pancreatic ducts to ERCP. It is used when the cause of a bile duct narrowing is unclear or when stones are too large for standard ERCP, so that a targeted biopsy or stone treatment can be done in the same procedure.