Initially, an ERCP is performed, and the common bile duct (CBD) is cannulated. Using a guidewire, the Spyglass™ is then passed up the CBD. This allows procedures to be performed under direct visualization.

This procedure requires a significant amount of training to be able to perform, and is practiced only by a limited amount of specialists. It carries the same risks as described for ERCP.

Procedures performed using Spyglass™ include:

• Direct sampling of biliary tract tumours. These tumours are often hard to diagnose, as other conditions may mimic them. Biopsy with histological examination can confirm/exclude the diagnosis, thereby expediting treatment or avoiding unnecessary procedures and surgery.
• Treatment of strictures where conventional ERCP has failed. Due to the technical limitations of ERCP, it is sometimes impossible to manage strictures (narrowings) appropriately. Direct visualization allows more targeted management of these lesions, as well as sampling for histological examination to assist with diagnosis.
• Removal of large gallstones where conventional ERCP has failed. If very large gallstones are present in the biliary system, it may not be possible to remove them using conventional ERCP techniques. Spyglass™ allows the use of a laser device which breaks up the stones into smaller, removable pieces.