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Inside Tract - New colangioscope proves its worth for PSC and more

Inside Tract Spring 2011

New colangioscope proves its worth for PSC and more

Date: April 1, 2011

Zhiping Li
Zhiping Li

For almost three years gastroenterologist Zhiping Li has used the new SpyGlass cholangioscope to help manage PSC (primary sclerosing cholangitis) in patients with the disease’s telltale symptoms. But the device’s benefits go beyond the purely clinical: Its greater ability to monitor the biliary tree encourages new research into therapy.

No one at Hopkins now questions the medical utility of SpyGlass, says Li. Unlike standard techniques that use X-ray images to highlight the bile duct strictures that mark the disease, SpyGlass eliminates the imaging middleman.

“In addition to probing strictures firsthand, we now observe characteristic fibrotic tissue lining in bile ducts or even more subtle changes,” Li adds. The new technology is also making clearer whether biopsy is warranted to rule out cancer and it enables tissue-sampling, if necessary, during the same session.

“Being able to visualize all of the quadrants of the duct system, and at the same time, zero in on what looks suspicious and sample it, gives us something that we now realize is marvelously efficient.”

Another plus: SpyGlass-assisted biopsies yield more cells to send to pathologists than traditional endoscopy-based brush biopsy.

Unfortunately, what hasn’t changed is the fact that PSC too-often ends in a liver transplant roughly two decades after diagnosis. “Medical management may help some and improve quality of life,” says Li. Balloon dilatation, for example, can break through the “dominant” strictures due to scarring and ease bile flow.

“But we have no therapies that reliably, significantly slow the disease,” he says, “or stop it altogether.”      

This year, in part because of the better monitoring ability, Li and colleagues have planned a trial of applying an existing medication directly inside bile ducts. The idea, he says, is to slow PSC’s progression.

“If we could keep patients fairly healthy, say, another decade or so,” says Li, “that’s a realistic goal for something that’s not a cure.”

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