Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan.
Clin Gastroenterol Hepatol. 2010 Nov;8(11):934-8. doi: 10.1016/j.cgh.2010.06.029. Epub 2010 Jul 22.
BACKGROUND & AIMS: We evaluated the diagnostic ability of a newly developed peroral video cholangioscopy (PVCS) in patients with pancreaticobiliary disorders.
We retrospectively evaluated data from 144 patients with pancreaticobiliary disorders, collected from 5 tertiary referral centers. Endoscopic sphincterotomy (EST) or endoscopic papillary balloon dilation (EPBD) was performed before PVCS. We performed 2 types of PVCS, using a conventional therapeutic duodenoscope. If tissue samples were needed, cholangioscopy-assisted biopsy or fluoroscopy-guided biopsy was performed.
PVCS was advanced into the bile duct in all cases after patients received EST (n = 134 cases), EPBD (n = 2), a combination of EST and EPBD (n = 1), or without treatment of the major papilla (n = 7). Biopsy samples were collected successfully from 112 of 120 cases in which endoscopists considered tissue sampling necessary. Endoscopic retrograde cholangiopancreatography (ERCP)/biopsy correctly identified 83 of 96 malignant lesions and 19 of 24 benign lesions (accuracy = 85.0%; sensitivity = 86.5%; specificity = 79.2%; positive predictive value = 94.3%; negative predictive value = 59.4%). Endoscopic retrograde cholangiopancreatography (ERCP)/biopsy plus PVCS correctly identified 95 of 96 malignant lesions and 23 of 24 benign lesions (accuracy = 98.3%; sensitivity = 99.0%; specificity = 95.8%; positive predictive value = 99.0%; negative predictive value = 95.8%). Procedure-related complications included pancreatitis (4 cases, 2.8%) and cholangitis (6 cases, 4.3%).
PVCS is an accurate diagnostic tool for patients with pancreaticobiliary disorders; resolution was well-defined when combined with biopsy analysis. Prospective multicenter clinical trials should evaluate the clinical utility of PVCS in diagnosis of biliary tract diseases.
我们评估了一种新开发的经口视频胆管镜（PVCS）在胰胆疾病患者中的诊断能力。
我们回顾性评估了来自 5 家三级转诊中心的 144 例胰胆疾病患者的数据。在 PVCS 之前进行内镜下括约肌切开术（EST）或内镜乳头气囊扩张术（EPBD）。我们使用常规治疗性十二指肠镜进行了 2 种类型的 PVCS。如果需要组织样本，则进行胆管镜辅助活检或透视引导活检。
在接受 EST（n = 134 例）、EPBD（n = 2 例）、EST 和 EPBD 联合（n = 1 例）或不治疗主要乳头（n = 7 例）治疗后，所有病例均成功将 PVCS 推进胆管。内镜医师认为有必要进行组织取样的 120 例中有 112 例成功采集了活检样本。内镜逆行胰胆管造影术（ERCP）/活检正确识别了 96 个恶性病变中的 83 个和 24 个良性病变中的 19 个（准确率 = 85.0%；灵敏度 = 86.5%；特异性 = 79.2%；阳性预测值 = 94.3%；阴性预测值 = 59.4%）。ERCP/活检加 PVCS 正确识别了 96 个恶性病变中的 95 个和 24 个良性病变中的 23 个（准确率 = 98.3%；灵敏度 = 99.0%；特异性 = 95.8%；阳性预测值 = 99.0%；阴性预测值 = 95.8%）。与操作相关的并发症包括胰腺炎（4 例，2.8%）和胆管炎（6 例，4.3%）。
PVCS 是胰胆疾病患者的一种准确诊断工具；与活检分析相结合时，分辨率良好。应进行前瞻性多中心临床试验，以评估 PVCS 在胆道疾病诊断中的临床应用价值。
