About one in 10 people suffer from gallstones, which are hard, pebble-like deposits that form inside the gallbladder. "Gallstones may be as small as a grain of sand or as large as a golf ball," explained Gastroenterologist William Kolozsi, M.D.
"Gallstones can occur when there is too much cholesterol or bilirubin in the bile, which is a liquid made in the liver that helps the body digest fats. About 90 percent of gallstones are made out of cholesterol that crystallizes to form stones. These stones may move into the gallbladder or bile ducts, where they can grow.
"If left untreated, gallstones can block the bile duct and interfere with the normal flow of bile and the body's digestion. This can lead to very painful gas-like symptoms, fever, and chills. Eventually, bacteria may build up behind the blockage, causing serious infection.
"Gallbladder inflammation usually results from a gallstone blocking the flow of bile. The pain of a gallbladder attack usually begins suddenly about one to two hours after eating a high-fat meal, and is most likely to occur in the right upper abdomen, under the ribs. Abdominal pain, nausea, vomiting or a bloated feeling in the stomach and chest are the most common symptoms."
Although anyone may develop gallstones, Dr. Kolozsi says a high-fat diet is a big risk factor. Gallstones are also more common in women than men, and generally they are found in people over 40. Those who are overweight are at a greater risk for developing this condition, as are those with rapid weight loss, advanced age or who are pregnant or use cholesterol-lowering drugs.
In the past, the evaluation and treatment of gallstones or other conditions in the biliary ducts and pancreas required that surgery be performed, or that an ERCP procedure be conducted using an endoscopy and x-ray with special contrast dye. The surgery could be tricky, depending on the size of the gallstone, which may be as large as a golf ball; and the drawbacks were that it could take weeks to recover from surgery.
At times, an ERCP has the disadvantage of limited visibility when it comes to clarifying issues in the narrower passageways of the bile and pancreatic ducts. Two-dimensional X-ray images cannot always provide enough information to obtain a complete diagnosis, which may lead to the need for additional complicated procedures.
However, advanced Spyglass technology can now be used in some cases to avoid these traditional treatment methods.
"With the SpyGlass Direct Visualization System, gallstone removal takes less than an hour and requires no incisions," Dr. Kolozsi said. "The SpyGlass uses a small flexible tube, called an endoscope, with a light and a video camera at the end. The tiny SpyGlass camera is not much bigger than the thickness of a human hair, and can be steered in four directions through a special catheter.
"A fiber optic probe attaches to the camera head and is designed to allow a physician to access and inspect all four quadrants of the treatment area. The new technology is able to enter tiny areas, such as bile ducts, where larger scopes can't go. As a result, we are able to achieve a more accurate diagnosis for our patients."
If needed, a special enhancement called Spybite, can take samples of suspicious tissue for evaluation, using miniature forceps. It also has the ability to insert a small probe against the gallstone to break it up with shock waves similar to removing kidney stones.
"Now with the aid of the SpyGlass, the stones can be broken up within the duct by using sound waves and then removed," he advised.
The Gastroenterology Center of Salem, a service of Salem Community Hospital, is one of only 300 facilities nationwide to use Spyglass technology to visualize the bile ducts and the gallbladder. The result is better diagnosis and treatment of obstructions, such as gallstones, suspicious lesions and other conditions of the biliary system. In addition, a biopsy can also be taken during an examination, eliminating the need for additional invasive procedures and prolonged recovery times.
"This cutting-edge technology is definitely altering the way we diagnose and treat patients with liver, gallbladder and bile duct conditions," Dr. Kolozsi concluded. "For example with cancer patients, we can biopsy with more certainty and provide greater information to create a more accurate plan for treatment. In the tight quarters of the bile duct, the camera improves visualization markedly. It can pinpoint the tumor and the tiny forceps weave up alongside to snip a small sample of the tissue.
"Overall, the Spyglass technology provides a more precise image, and this in turn yields a more accurate diagnosis and more successful treatment outcome for our patients."
Wiliam Z. Kolozsi, M.D., is a gastroenterologist affiliated with Salem Community Hospital's active medical staff. His office is located at 2020 East State Street, Suite H, in Salem, 330-337-8709.