Center for Endoscopic Research and Therapeutics, Section of Gastroenterology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois 60637, USA.
Gastrointest Endosc. 2010 Nov;72(5):1052-6. doi: 10.1016/j.gie.2010.06.048. Epub 2010 Sep 19.
Advantages of direct peroral cholangioscopy (DPOCS) by using an ultraslim endoscope include a single-operator platform, image quality equal to that of standard endoscopy, and separate water and air channels. However, DPOCS has significant limitations, including cumbersome biliary access, en-face position with the ampulla, and gastric looping of the endoscope. A newly designed anchoring balloon may overcome these challenges.
To report the feasibility of DPOCS with the anchoring balloon.
Pilot study, porcine model.
Animal resources center.
The anchoring balloon system developed by Cook Medical (Winston-Salem, NC) was used for DPOCS.
Primary: Feasibility of biliary access maintenance and intraductal mobility. Secondary: Feasibility of intraductal therapeutic procedures.
Four animal subjects underwent DPOCS with the anchoring balloon. Ductal access was achieved with sphincterotomy in 2 subjects and with a balloon sphincteroplasty in 2 subjects. Intraductal placement of the ultraslim endoscope was achieved in all biliary access attempts without balloon migration or deflation. Common bile duct, cystic duct, bifurcation, and main right and left duct direct visualization was achieved in all cases. Therapeutic interventions by DPOCS, including intraductal biopsy, balloon dilatation, and intraductal bilateral metal stent placement, were all completed successfully. Biliary perforation occurred in one case because of balloon overinflation and in a second case because of sphincterotomy.
Prototype study in an animal model and small study size.
Our results show that the novel anchoring balloon system successfully and safely enables DPOCS for both diagnostic and therapeutic interventions. If corroborated in human trials, it could offer a new platform for biliary interventions.
使用超微型内镜进行直接经口胆胰管镜检查（DPOCS）的优势包括单操作员平台、与标准内镜相当的图像质量以及单独的水和空气通道。然而，DPOCS 存在显著的局限性，包括胆道进入操作繁琐、乳头呈直面位以及内镜在胃内成袢。一种新设计的定位球囊可能克服这些挑战。
报告使用定位球囊进行 DPOCS 的可行性。
试点研究，猪模型。
动物资源中心。
使用 Cook Medical（北卡罗来纳州温斯顿-塞勒姆）开发的定位球囊系统进行 DPOCS。
主要指标：胆道维持和腔内活动性的可行性。次要指标：腔内治疗程序的可行性。
4 只动物接受了定位球囊辅助的 DPOCS。2 只动物通过括约肌切开术实现了胆管进入，2 只动物通过球囊扩约肌成形术实现了胆管进入。在所有胆管进入尝试中，均成功地将超微型内镜插入胆管，而无球囊迁移或放气。在所有病例中，均成功地实现了胆总管、胆囊管、分叉、主右和左胆管的直接可视化。通过 DPOCS 完成了多项治疗性干预，包括腔内活检、球囊扩张和腔内双侧金属支架放置。1 例因球囊过度充气导致胆道穿孔，另 1 例因括约肌切开术导致胆道穿孔。
动物模型的原型研究和小样本量。
我们的结果表明，新型定位球囊系统成功且安全地实现了 DPOCS 的诊断和治疗干预。如果在人体试验中得到证实，它可能为胆道介入提供一个新的平台。
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