Here’s an axiom you almost never hear in today’s medical world.
“What you don’t know probably won’t hurt you.”
But according to the folks at WebMD, when it comes to gallstones, that’s sage advice. For most people.
Until it isn’t.
Roughly 10 percent of all men and 20 percent of all women in the U.S. either have gallstones now or will develop them at some point during their lives.
The good news? Most of those folks will have no symptoms whatsoever as their gallstones – which can be as small as a grain of sand – float harmlessly around inside their gallbladders.
The Mayo Clinic describes gallstones as “hardened deposits of digestive fluids” and while most are tiny, sometimes they can grow quite large.
In fact, they can grow as large as a golf ball and nobody should have a Titleist inside their gallbladder.
The pain gallstones are capable of causing can be excruciating and that’s where Dr. Alec Lui, board-certified in both internal medicine and gastroenterology, along with his latest generation “SpyGlass” endoscope can work wonders.
The National Institute of Diabetes and Digestive and Kidney Diseases at the National Institutes of Health says the pain of a gallbladder attack (also known as biliary colic) “occurs when gallstones block the ducts inside the biliary tract.”
The biliary tract consists of the gallbladder and the bile ducts. Bile ducts, as the name implies, carry bile and other digestive enzymes from the liver and pancreas to the small intestine to aid in digestion of fats and fat-soluble vitamins such as vitamins A, D, E and K.
Because of that fat-centric mission, bile is largely composed of cholesterol, salts and a substance called bilirubin.
And when one of those bile ducts is blocked, the result can be a sudden and rapidly intensifying pain. Starting in the abdomen, the pain sometimes spreads all the way up to the shoulder.
To fight such a big pain, it seems, sometimes you need a tiny – maybe even downright Lilliputian – device, and Dr. Lui is a master of just such a piece of equipment: the “SpyGlass” endoscope.
The University of Nebraska Medical School says “removing large gallstones used to require major surgery. Not anymore. With the SpyGlass Direct Visualization System, gallstone removal takes less than an hour and requires no incisions.”
SpyGlass is essentially a hyper-small, flexible tube with a light and a high-resolution Olympus video camera at the end. It is able to enter tiny areas like bile ducts, which the U.S. National Library of Medicine says can be as narrow as 2.8 millimeters, and yet it still packs a variety of highly miniaturized tools which can be used to address any problems it finds.
The SpyGlass is, in fact, an endoscope within a somewhat larger endoscope.
“We use the larger endoscope, which we call the mother scope, to identify the opening, and then we use SpyGlass to enter the area we want to examine,” Lui says. “If the stones are small, you pull them out with a basket or a balloon.”
For larger gallstones, he continues, “you can get the SpyGlass right up close to the stone. The SpyGlass has a channel through which you can pass instruments including what’s known as an electro-hydraulic lithotripter.”
That device uses high-energy shock waves to shatter or crush such stones into small, manageable pieces which can then be scooped up and removed.
But the SpyGlass system is capable of tackling much more than gallstones. It is also used to diagnose and biopsy cancer of the bile duct, a condition known as cholangiocarcinoma.
While cholangiocarcinoma is not a particularly common cancer, SpyGlass has given gastroenterologists like Lui a valuable tool to diagnose and treat the disease in its earliest stages.
Aside from its multi-purpose capabilities, Lui points to another positive of the latest generation of SpyGlass.
“It’s easier to set up,” he says with a smile. “It only takes about five minutes. The second thing is that it gets a much better image. You see it a lot clearer inside the bile duct compared to the first generation; it’s more maneuverable and easier to steer.”
Dr. Alec Lui is affiliated with both the Sebastian River Medical Center and IRMC. His Sebastian office is at 13845 U.S. Highway 1. The phone number is 772-589-9071. His Vero office is at 275 18th Street, Suite 102. That phone number in Vero is 772-562-6818.
