Chak Amitabh, Catanzaro Andrew
Case Western Reserve University School of Medicine, Division of Gastroenterology, USA.
Gastrointest Endosc Clin N Am. 2003 Oct;13(4):609-22. doi: 10.1016/s1052-5157(03)00068-0.
Tissue can be acquired from the bile and pancreatic duct with either brush cytology or biopsy forceps, often without the need for sphincterotomy. Although the diagnosis of malignancy with these sampling techniques is often specific, the sensitivity is limited, and a wide range of diagnostic accuracies has been reported. A combination of biopsy and brush cytology along with some newer techniques in the development stage may increase the sensitivity. Intraductal ultrasound is a newer technique offers the endoscopist the ability to image the bile and pancreatic duct wall, adjacent organs, and vascular structures with a high degree of detail. This visualization can be accomplished during the course of an ERCP or percutaneously under fluoroscopic guidance. Indications for the procedure include detection of choledocholithiasis, differentiation of benign and malignant ductal strictures, pancreaticobiliary tumor staging, and detection of various pancreatic tumors. Continued research into the design of the probes, which could improve durability and extend the depth of penetration, may promote more widespread use of this novel technology.
可通过刷检细胞学或活检钳从胆管和胰管获取组织，通常无需进行括约肌切开术。尽管使用这些采样技术诊断恶性肿瘤往往具有特异性，但敏感性有限，且已报道的诊断准确性范围很广。活检和刷检细胞学相结合以及一些处于研发阶段的新技术可能会提高敏感性。导管内超声是一种较新的技术，能让内镜医师非常详细地对胆管和胰管壁、相邻器官及血管结构进行成像。这种可视化可在ERCP过程中或在荧光透视引导下经皮完成。该检查的适应证包括胆总管结石的检测、良恶性导管狭窄的鉴别、胰胆管肿瘤分期以及各种胰腺肿瘤的检测。对探头设计的持续研究，有望提高其耐用性并增加穿透深度，这可能会促使这项新技术得到更广泛的应用。
