Department of Internal Medicine, Soon Chun Hyang University School of Medicine, Bucheon, Korea.
J Hepatobiliary Pancreat Sci. 2011 May;18(3):350-6. doi: 10.1007/s00534-010-0353-6.
Peroral cholangioscopy provides direct visualization of the bile duct and facilitates diagnostic procedures and therapeutic intervention. The currently available mother-baby scope system is not widely used because of its disadvantages. Direct peroral cholangioscopy (POC) with a regular, ultra-slim, upper endoscope can provide a valuable and economic solution for evaluating bile duct lesions, although its therapeutic role in biliary tract disease is uncertain. We assessed the usefulness of direct POC with an ultra-slim endoscope for therapeutic application in patients with biliary diseases.
Several new techniques and accessories allow therapeutic intervention under direct POC using an ultra-slim upper endoscope with a larger, 2-mm working channel. Intracorporeal laser or electrohydraulic lithotripsy under direct POC is a main therapeutic intervention for patients with bile duct stones resistant to conventional endoscopic procedures. Tumor ablation therapy such as photodynamic therapy and argon plasma coagulation may be performed under direct POC. Direct POC can be applied to guide biliary interventions such as guidewire placement, stone removal, and migrated stent retrieval, using diverse accessories.
Direct POC with an ultra-slim upper endoscope allows therapeutic intervention for patients with biliary diseases. Enhancements of the endoscope and specialized accessories are expected to expand the therapeutic role of direct POC.
经口胆胰管镜检查可直接观察胆管，并有助于诊断和治疗。目前可用的子母镜系统因其缺点而未广泛应用。使用常规的超细上消化道内镜进行直接经口胆胰管镜检查（POC）可以为评估胆管病变提供有价值且经济的解决方案，尽管其在胆道疾病中的治疗作用尚不确定。我们评估了使用超细内镜进行直接 POC 在治疗胆道疾病患者中的应用价值。
几种新技术和附件允许使用带有更大 2mm 工作通道的超细上消化道内镜进行直接 POC 下的治疗干预。经腔内激光或液电碎石术是对常规内镜治疗有抵抗的胆管结石患者的主要治疗干预措施。经直接 POC 可以进行肿瘤消融治疗，如光动力疗法和氩等离子凝固术。直接 POC 可以应用于指导胆道介入治疗，如导丝放置、取石和迁移支架取出，使用各种附件。
使用超细上消化道内镜进行直接 POC 可对胆道疾病患者进行治疗干预。预计内镜和专用附件的改进将扩大直接 POC 的治疗作用。
