New technique spares patients time consuming surgery by blasting painful gallstones

with powerful shockwaves

SpyGlass destroys stones that form in or become lodged in the bile

duct
Device is passed down the throat using an endoscope allowing direct
view
Tiny probe emits bursts of electrical current to shatter the lodged
stones
By Roger Dobson for The Mail on Sunday

A treatment that blasts away gallstones that have found their way into the hard-to-reach
bile duct is bringing relief to patients in pain while sparing them major surgery that
requires a week in hospital.

The treatment uses an electric current that creates shockwaves to shatter the stones in
minutes, with no incisions required.

Gallstones are small stones usually made of cholesterol that form in the gall bladder, the
small, pouch-like organ found underneath the liver which stores bile, and can grow to the
size of a golf ball.

TV gardener Alan Titchmarsh was last month diagnosed with the condition after being
airlifted to hospital in agony after a meal.

Problems can arise when stones form or become lodged in the bile ducts tubes that carry
bile from the liver and gall bladder to the small bowel, causing severe abdominal pain,
fever and complications such as jaundice.

These stones can be tricky to treat, as, unlike kidney stones, they cannot often be broken up
with external soundwaves.

Surgical removal of the entire gall bladder can sort out the problem if stones are in the gall
bladder only, but an endoscopic approach known as ERCP is usually needed for stones
stuck in the bile duct.

Now a device called the SpyGlass is being used to destroy stones that form in or become
lodged in the bile duct, and cant be removed by other means.

Like ERCP, the Spyglass is passed down the throat using an endoscope.But unlike ERCP,
which relies on X-rays to locate and work on stones, Spyglass allows the direct
visualisation of stones or other problems inside the bile duct.

SpyGlass is a small flexible tube, little wider than a drinking straw, with a light and a
1mm-wide video camera at the end.
It is passed down the patients throat, through the stomach, and then up into the bile duct.

When the stone has been located, a tiny probe inside the tube emits bursts of electrical
current to shatter the stone, with the doctor using a foot pedal to control the flow of the
current while keeping an eye on a screen. The fragmenting process is called
electrohydraulic lithotripsy.

A laser can also be used to break up the stone.

Gallstones are usually made of cholesterol that form in the gall bladder and can grow to the size of a golf ball

Any remaining pieces of stone either pass through the duct or are removed using tiny
baskets or balloons to catch the fragments.

Dr George Webster, consultant gastroenterologist at University College Hospital, London,

says the treatment has a 90 per cent success rate on the 100 patients he has treated so far.
It is a great advance, he adds. We can treat people who could not previously be
adequately treated without quite major surgery.

For suitable patients, it means a 30- to 90-minute day-case procedure instead of surgery
and a hospital stay of several days.

Dr Webster adds that the device may also be used to help detect early-stage bile-duct
cancers.

The direct visualisation that is offered with this device means we may identify tumours at
an earlier stage than was previously possible, he says.

Until now we have often not been able to see the tumour directly, but have relied on X-
rays. In some cases this may result in patients with a small tumour which may be most
treatable having an unavoidable delay in diagnosis.
The SpyGlass destroys gallstones that become lodged in the bile duct, and cant be removed by other means

As many as one in ten adults have gallstones at some time, but in most cases they cause no
problems and no treatment is needed. Being female, over 40 or overweight can increase the
risk.

About 25,000 people are treated for bile-duct stones each year, normally with the more
complicated ERCP procedure, officially known as endoscopic retrograde
cholangiopancreatography.

Dr Websters patients include 70-year-old Robert Dolder, from Crowborough, East Sussex.
He twice underwent ERCP to remove bile-duct stones, both times involving overnight
stays in hospital.

When the pain persisted, he was referred to Dr Webster.

He had the Spyglass treatment earlier this month and his stones, one just over 1cm in
diameter, were fragmented and removed.

He says: I was in theatre, sedated but awake, for about 90 minutes. It was a complete
success. I came home the same day and I feel fine.

Read more: http://www.dailymail.co.uk/health/article-3555243/Revolutionary-technique-spares-patients-time-

consuming-surgery-blasting-painful-gallstones-powerful-shockwaves.html#ixzz4iedZQYrm
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