Hoffman A, Kiesslich R, Bittinger F, Galle P R, Neurath M F
Medical Clinic I, Johannes Gutenberg University of Mainz, Mainz, Germany.
Endoscopy. 2008 Jul;40(7):563-71. doi: 10.1055/s-2007-995688. Epub 2008 Apr 11.
Chromoendoscopy using methylene blue is employed in the gastrointestinal tract to delineate neoplastic lesions. We tested the value of chromoendoscopy during choledochoscopy for characterization of local inflammation, neoplasias, and other alterations in patients with biliary strictures.
Patients with suspected biliary lesions were scheduled for endoscopic retrograde cholangiography with subsequent cholangioscopy. After initial inspection of the bile duct, 15 ml methylene blue (0.1 %) was administered via the working channel of the cholangioscope. Newly appearing circumscribed or unstained lesions were judged according to their macroscopic type and staining features. Methylene-blue-aided diagnosis was compared with either clinical follow-up of the patients or, in some cases, with the results of targeted biopsies.
A total of 55 patients [biliary stenosis/cholestasis of unknown origin (n = 24), stenosis after orthotopic liver transplantation (n = 11), primary sclerosing cholangitis (n = 20)] were included. Methylene blue unmasked subtle mucosal changes and permitted macroscopic characterization of circumscribed lesions. Characteristic surface staining patterns were seen in chronic inflammation, dysplasia, and ischemic-type biliary lesions. Nondysplastic mucosa appeared homogeneously stained, whereas scarred strictures showed a weak uptake of methylene blue.
In this prospective feasibility study, methylene-blue-aided cholangioscopy was used for the first time to define different staining patterns of the bile duct. The differences in staining patterns identified normal, dysplastic, and inflamed mucosa of the bile duct, as was proved by follow-up or, in some cases, histology. Whereas homogeneous staining predicted the presence of normal mucosa, absence of staining of circumscribed lesions, or diffused staining of such lesions, represented neoplastic changes or inflammation.
使用亚甲蓝的染色内镜检查用于胃肠道以勾勒肿瘤性病变。我们测试了在胆管镜检查期间进行染色内镜检查对胆管狭窄患者局部炎症、肿瘤形成及其他改变进行特征化诊断的价值。
疑似胆管病变的患者计划接受内镜逆行胆管造影及随后的胆管镜检查。在对胆管进行初步检查后，通过胆管镜的工作通道注入15毫升亚甲蓝（0.1%）。根据新出现的局限性或未染色病变的宏观类型和染色特征进行判断。将亚甲蓝辅助诊断与患者的临床随访结果或在某些情况下与靶向活检结果进行比较。
共纳入55例患者[不明原因的胆管狭窄/胆汁淤积（n = 24）、原位肝移植术后狭窄（n = 11）、原发性硬化性胆管炎（n = 20）]。亚甲蓝揭示了细微的黏膜变化，并允许对局限性病变进行宏观特征化。在慢性炎症、发育异常和缺血性胆管病变中可见特征性的表面染色模式。非发育异常的黏膜呈现均匀染色，而瘢痕性狭窄对亚甲蓝的摄取较弱。
在这项前瞻性可行性研究中，首次使用亚甲蓝辅助胆管镜检查来定义胆管的不同染色模式。染色模式的差异识别出胆管的正常、发育异常和炎症黏膜，这在随访中或在某些情况下通过组织学得到证实。均匀染色预示正常黏膜的存在，局限性病变无染色或此类病变的弥漫性染色代表肿瘤性改变或炎症。
