Since its introduction, further studies with varying sample sizes (n=5 to n=226) have shown the SDVS to be an effective therapeutic and diagnostic tool ( 3, 4). In 2009, The US Food and Drug Administration granted approval for the use of SDVS for endoscopic pancreatobiliary use, both for diagnosis and treatment ( 2). SDVS was the subject of an international study involving several centers with encouraging results ( 1).
The SpyGlass Direct Visualization System (SDVS) was developed to overcome a range of methodological problems present in earlier systems, including complex equipment setup, relative fragility of system components, high rates of medical complications following use, lack of an adequate accessory channel, unsatisfactory image quality, and the need for two endoscopists. Video-cholangioscopes, with their relatively more advanced technology and their striking visual quality, are now more widely available, but there are some associated problems. However, the low diagnostic value of brush cytology or blind intraductal forceps biopsy, frequently used in the diagnosis of the etiology of biliary strictures, and the challenges in the assessment and management of biliary tree pathologies may make it obligatory to examine the bile duct with direct imaging using a cholangioscope in these patients.ĭespite many improvements since the earliest cholangioscopy systems were developed, there are still many aspects of this methodology that could benefit from further improvement. The standard examination technique for patients suspected with hepatobiliary duct disease is an evaluation of cholangiograms during endoscopic retrograde cholangiopancreatography (ERCP) if previous magnetic resonance cholangiopancreatography (MRCP) or other radiological techniques have been unsuccessful.
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