By Dawn Brazell
Public Relations

It's good that M. Boyd Gillespie, M.D., loves fishing — the patience of waiting for just the right moment for a trout to connect to his line, the sudden rush of excitement when he knows it's hooked.

It's a trait that translates well to his surgical work involving salivary endoscopy, a delicate 'miniature' surgery, using small instruments to get into the tiny opening of salivary glands to remove blockages that can cause patients swelling, discomfort and, in some cases, infection. He sometimes uses a tool called a basket catcher to trap a stone that is whirling around — a procedure not totally unlike hooking a fish.

MUSC has become a training center for salivary endoscopy, a procedure that originated about 10 years ago in Germany, where the miniature instruments were first introduced.

"I went to Germany and became trained in this. We acquired the equipment at MUSC and have become the nation's leader in this treatment. We're currently the busiest endoscopic salivary gland center in the United States," he said. "Anytime you have a service in your department that has a national reputation, it improves the profile of your department."

Gillespie, an otolaryngologist, has performed more than 200 procedures since he began doing salivary endoscopy at MUSC in 2008. Patients have come from across the nation — 16 different states — to have it done. Often finding him via the Internet, out-of-town patients usually combine consulting with him with a sight-seeing trip to Charleston, he said.

MUSC also serves as a training site for salivary endoscopy with the Department of Otolarygology having provided training for 60 surgeons from institutions such as Johns Hopkins University to M.D. Anderson Cancer Center. Hands-on training in salivary endoscopy will be held at MUSC, Oct. 21-22, during the Head and Neck Oncology Summit Meeting in Charleston.

Gillespie said he's glad to see the technique's use expand.

Dr. M. Boyd Gillespie has performed more than 200 procedures since he began doing salivary endoscopy at MUSC in 2008. To see a video about the procedure, visit http://tinyurl.com/3hnb6wr.

Previously the only way to treat blockages in these glands was to surgically remove them, requiring an incision on the face and neck in a procedure that puts certain nerves at risk. Salivary gland blockage can result from multiple causes, including salivary stones, scar tissue, allergic disorders, auto-immune diseases and as a side-effect from certain medications. The most common cause of obstruction is salivary stones that are thought to form from mucous sludge, which becomes mineralized with deposits of calcium hydroxylapatite.

Blockages occur in about 1 in 10,000 people a year, which means about 30 cases a year in Charleston. Open surgery would be a two-to-three-hour operation and one to two days in the hospital, whereas the endoscopy can be done in about an hour as an outpatient treatment.

As long as a stone isn't blocking a gland, people can be asymptomatic, but the stones tend to grow over time, he said. Saliva has calcium in it, which can deposit small grain-like layers. People with dry mouth and smokers seem to be more at risk to develop stones. For patients who do develop a blockage, it really can affect their quality of life.

Gillespie, who has provided keynote talks in this area, said he's glad to see advances being made as the instrumentation evolves, including a balloon-like device that will help stretch and open ducts similar to what's done with angioplasty for the heart. The ductal system is collapsible and mobile, which means it takes specialized training and precision instruments for a surgeon to navigate the bends and turns.

He likes maintaining ties with colleagues at the salivary center at Erlangen-Nurnberg, Germany, with whom he publishes papers. He travels there in February to assist with training, and their center sends experts here for training in the fall.

"It's a good collaboration."

For more information on the department, visit http://www.muschealth.com/ent.