Al Knoell lay anesthetized on his stomach as Dr. Mike Schafer used a thin tube with a camera on it to probe caverns near Knoell’s pancreas and liver.
The technology Schafer used is the latest available to explore with a clearer view tiny ducts and passageways that may have narrowed or been blocked by stones or tumors. Although a system existed before to root through some of the small branches around the liver, pancreas and gall bladder, the picture available to gastroenterologists was sometimes foggy. The fog has cleared.
“The image quality is vastly improved,” Schafer said before the procedure last week at Methodist Hospital.
Schafer has used the Boston Scientific technology in more than 15 cases. Methodist had the device in the spring, and Nebraska Medicine system and Bryan Health in Lincoln have followed. CHI Health is looking into acquiring it. The device was approved for use by the Food and Drug Administration early this year.
Dr. Grant Hutchins, director of endoscopic services for Nebraska Medicine, said he has used the technology about 10 times. Hutchins said he loved the sharper image the technology gives.
“It has the potential to change the way we provide pancreatic and biliary medicine,” Hutchins said. “It’s such an upgrade, it’s just amazing.”
Schafer’s father, gastroenterologist Dr. Ed Schafer, demonstrated to a reporter seven years ago the first generation of SpyGlass, which used fiber-optic technology, at the Nebraska Medical Center. His son says the live, high-definition digital video provided by the new version, called SpyGlass DS for digital and simple, makes the old version seem like peering through cataracts.
The Schafers are partners in Midwest Gastrointestinal Associates, an Omaha firm of about 25 specialists.
The catheter channel is only 3.3 millimeters in diameter, or a little bigger than one-eighth of an inch, and provides access into many small ducts and portals in the vicinity of the liver, gall bladder and pancreas. Mike Schafer said he could envision the equipment eventually being used to look at ducts and openings in other parts of the body, such as the ureter and the lungs.
In the 73-year-old Knoell’s case, Schafer used the SpyGlass to biopsy a tumor in the pancreatic duct. Schafer also looked for other reasons for Knoell’s severe abdominal pain.
The tumor already had been declared most likely inoperable because it was so close to, or surrounded by, blood vessels.
Schafer said the technology is excellent in helping ascertain hard-to-get diagnoses.
During the hour-and-a-half procedure on Knoell, Schafer saw the blood vessels feeding the tumor in the pancreatic duct. Schafer controlled the camera’s movement with a gadget in his left hand and threaded the catheter through a scope in the patient’s mouth and throat with his right. By adding a small clipping device onto the end of the SpyGlass scope, Schafer was able to remove pieces of the tumor.
He and nurse Darbi Eschmann then placed the tiny pieces into a liquid preservative for laboratory testing. After Schafer pulled off an adequate piece, Eschmann said: “That’s a good one.”
Schafer used SpyGlass through about half of the procedure. Some of his work, such as an ultrasound, didn’t require the new technology.
The equipment also has the capacity to deploy laser and shock-wave technology to break up stones that block ducts.
Methodist and Nebraska Medicine declined to provide any estimate or range of patient costs in cases where the technology is used. They also declined to say how much they paid for the equipment.
An organization that tracks the price of procedures, Healthcare Bluebook of Tennessee, said a national sample of data on similar procedures reflects a wide range of prices facing patients after insurance kicks in, from $3,100 to $15,630 for hospital and doctor services. The group’s data didn’t reflect whether SpyGlass DS or the older SpyGlass or some other technology was used in the many cases examined by Healthcare Bluebook’s Bill Kampine.
A national organization that tracks medical costs, Philadelphia-based ECRI Institute, said the sticker price on the computer processor to run SpyGlass DS is $99,500 and the disposable catheter and hand control is $3,000. A Methodist spokeswoman said it has a rental agreement with Boston Scientific in which the company provides “the base equipment and we purchase the supplies for that equipment from them.”
Knoell hoped to get a firm diagnosis after months of feeling bad and experiencing pain. He awaited the outpatient procedure in a Methodist bed and looked spry.
“I don’t feel as good as I look,” Knoell (pronounced Nell) said. Knoell, of Fremont, made a career in the printing industry, but he wanted to talk about his music. He has played guitar and keyboards and sung in bands for years.
His current band, Down Memory Lane, plays country, rock, polkas and waltzes. “I play everything,” he said.
As of early this week, Knoell didn’t have a diagnosis but expected to have one soon.
Schafer said that with another patient, he used the technology to repair a leaky bile duct.
And for Michael Nisley of Omaha, Schafer peered into liver ducts and determined that only a portion of the liver had to be removed because of a pre-cancerous tumor.
Nisley said he avoided transplantation because of it.
“All I know is if this wouldn’t have worked, I would have been put on the (liver) transplant list, for sure,” Nisley, 55, said. “This is a new chance for me in life.”
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