Awadallah Nida S, Chen Yang K, Piraka Cyrus, Antillon Mainor R, Shah Raj J
Division of Gastroenterology, Department of Internal Medicine, University of Colorado Health Sciences Center, Denver, Colorado, USA.
Am J Gastroenterol. 2006 Feb;101(2):284-91. doi: 10.1111/j.1572-0241.2006.00383.x.
Assess the role of cholangioscopy in primary sclerosing cholangitis for 1) detection of cholangiocarcinoma using cholangioscopy-assisted biopsy 2) detection of stones not seen on cholangiography 3) stone removal with cholangioscopy-directed lithotripsy.
Prospective cohort of consecutive patients referred for cholangioscopy to evaluate dominant strictures or stones. A data collection sheet was employed. Follow-up was by chart review/phone contact. Clinical improvement was defined as resolution of jaundice or > or =50% reduction in pain or cholangitis episodes requiring hospitalization.
41 patients (30M, 11F) had 60 cholangioscopy procedures (55 per oral, 5 percutaneous). 33/41 (80%) patients underwent 44 tissue sampling events.
positive for extrahepatic cholangiocarcinoma (N = 1), negative/atypical (N = 31), and inadequate (N = 1). Stones were found in 23/41 (56%) patients, of which 7/23 (30%) were missed on cholangiography and detected only by cholangioscopy. 9/23 (39%) underwent cholangioscopy-directed lithotripsy. Stone clearance: complete (N = 10, 7 by cholangioscopy-directed lithotripsy after failed conventional stone extraction); partial (N = 7); and not attempted (N = 6). Median follow-up was 17.0 months (range 1-56). Clinical improvement was achieved in 25/40 (63%). Eight patients have undergone transplant and cholangiocarcinoma was present in the explant of two at 1 and 12 months post-cholangioscopy, respectively.
This is the first series of patients with primary sclerosing cholangitis undergoing cholangioscopy for the evaluation of dominant strictures and cholangioscopy-directed stone therapy with demonstrable clinical benefits. Stones detected by cholangioscopy were missed by cholangiography in nearly one of three patients. Cholangioscopy-directed lithotripsy may be superior to conventional ERCP for achieving complete stone clearance. Despite the use of cholangioscopy, diagnosis of cholangiocarcinoma remains technically challenging.
评估胆管镜检查在原发性硬化性胆管炎中的作用，用于：1）通过胆管镜辅助活检检测胆管癌；2）检测胆管造影未发现的结石；3）通过胆管镜引导的碎石术清除结石。
对连续转诊接受胆管镜检查以评估主要狭窄或结石的患者进行前瞻性队列研究。使用数据收集表。通过病历审查/电话联系进行随访。临床改善定义为黄疸消退或疼痛减轻≥50%或需要住院治疗的胆管炎发作次数减少。
41例患者（30例男性，11例女性）接受了60次胆管镜检查（55次经口，5次经皮）。41例患者中的33例（80%）进行了44次组织采样。
肝外胆管癌阳性（N = 1），阴性/非典型（N = 31），不充分（N = 1）。41例患者中的23例（56%）发现结石，其中造影未发现而仅通过胆管镜检查发现的有7例（占23例中的30%）。23例中的9例（39%）接受了胆管镜引导的碎石术。结石清除情况：完全清除（N = 10，7例在传统结石取出失败后通过胆管镜引导的碎石术清除）；部分清除（N = 7）；未尝试清除（N = 6）。中位随访时间为17.0个月（范围1 - 56个月）。40例患者中的25例（63%）实现了临床改善。8例患者接受了移植，分别在胆管镜检查后1个月和第12个月时，2例患者的移植肝中发现了胆管癌。
这是首批对原发性硬化性胆管炎患者进行胆管镜检查以评估主要狭窄及胆管镜引导的结石治疗并证明有临床益处的系列研究。近三分之一的患者中，胆管造影遗漏了胆管镜检查发现的结石。胆管镜引导的碎石术在实现结石完全清除方面可能优于传统内镜逆行胰胆管造影（ERCP）。尽管使用了胆管镜检查，但胆管癌的诊断在技术上仍然具有挑战性。
