With the advantage of cutting- edge technology, Dr. Amjad Awan, a gastroenterologist at Pres­byterian Hospital of Denton, is getting a clearer view to diagnose and treat patients with liver, gallbladder and bile duct conditions such as obstructions, stones or cancers.

DRC/Al Key

Dr. Amjad Awan, a gastroenterologist at Presbyterian Hospital of Denton, is shown with the new SpyGlass Direct Visualization System.

The new SpyGlass Direct Visualization System at Presbyterian, available since December, is the only equipment of its kind in Denton and one of five in the Dallas-Fort Worth area.

“SpyGlass is increasingly helpful to diagnosing what we’re looking for,” Awan said.

The technology will assist physicians in overcoming some of the visual challenges of conventional Endoscopic Retrograde Cholangio-Pancreotography procedures, also known as ERCP for short.

While the new SpyGlass procedure takes approximately 15 minutes longer, it is more thorough than ERCP.

Conventional ERCP is hindered by the flat, two-dimensional, black-and-white image rendered by fluoroscopy, which can make it difficult to determine where to obtain tissue samples and can potentially lead to an inaccurate or inconclusive clinical diagnosis.

“It’s a day and night difference,” Awan said. “We can see inside rather than extrapolate from black-and-white negatives. It’s like a live color picture.”

Besides the inconvenience of patients having to return to the hospital, the ERCP procedure can take two or more hours and typically requires them not to eat or drink six to eight hours beforehand.

Data show that up to 30 percent of ERCPs performed using brush cytology or biopsy forceps for tissue diagnosis are inconclusive, potentially creating the need for additional testing or repeat procedures.

“The SpyGlass procedure is very helpful in clearly diagnosing and taking tissue biopsies of tissue cancer in the bile duct and pancreas as well as gallbladder concerns,” he said.

Also, pregnant women who cannot undergo X-ray are benefiting from SpyGlass.

“We can enter without using X-ray and exposing the fetus,” he said.

Just as in the traditional ERCP procedure, with the SpyGlass the physician uses an endoscope — a long, flexible, lighted tube that is inserted through a patient’s mouth and directed through the stomach into the first part of the small intestine — to be able to view the biliary tract’s entrance.

 A fiber optic probe attaches to a camera head and is inserted through a single-use catheter that can be steered in four directions. This is designed to allow the user to access and inspect all of the treatment area, resulting in an improved diagnosis for patients.

With the fiber optic probe, SpyGlass is small enough to feed directly into the treelike ducts of the liver.

The SpyGlass system, developed by Boston Scientific Corp., provides direct visual access into a patient’s biliary duct to improve diagnosis, acquire tissue samples and remove stones.

Patients with reoccurring stone formations are benefiting from the procedure, which provides a better chance to clean out residual stone particles.

“We make sure to completely clean every crystal and small speck so they don’t form again,” he said.

For cancer patients, they can biopsy with more certainty and make a more accurate plan for treatment and chem­otherapy, he said.

“We know what we are taking a biopsy of,” he said. “And, we’re less reluctant in diagnosis than before because before, we weren’t sure.”

Patricia Burke, 52, was scheduled for gallbladder surgery in October because of severe pain, but doctors during the procedure diagnosed her with pancreatic cancer.

“Pain medications weren’t helping, so Dr. Awan put a stint in to help,” she said.

While Awan used the SpyGlass to install the stent in Burke’s bile duct to correct the pinch and allow the gallbladder to drain, he also was able to see that the cancerous tumor had not spread to the inside of the pancreas.

Bourke, who still is undergoing chemotherapy, said she feels better since the SpyGlass procedure.

“Now the pain is almost gone to nothing,” she said.

Awan said on average, men have more cancers than women, while women typically have more stones, such as gallstones.

About 80 percent of people undergoing SpyGlass procedures are treated on an outpatient basis.

Currently, Awan is the only certified physician in Denton to conduct SpyGlass procedures. Ex­cited about the new system, Awan said he would train others in the future.

“This is amazing technology,” he said. “It’s such a step up.”