Department of Internal Medicine II, Dr. Horst Schmidt Kliniken (Medical School of the University of Mainz), Wiesbaden, Germany.
Gastrointest Endosc. 2011 Aug;74(2):309-16. doi: 10.1016/j.gie.2011.02.022.
Direct cholangioscopy using an ultraslim endoscope is an attractive alternative to the conventional mother-baby endoscope system because it provides a single-operator platform and high-resolution image quality and allows advanced therapeutic interventions. However, biliary access is cumbersome and usually requires previous guidewire placement via retrograde cholangiography.
To evaluate the feasibility of a 1-step transnasal cholangioscopy (TNC) technique using an ultraslim endoscope with an intraductal balloon to maintain access without previous guidewire placement.
Prospective, observational clinical feasibility study.
Single tertiary referral center.
Overall procedure success rates and complications. A successful procedure was defined as one in which the endoscope was advanced into the bifurcation or stenotic segment of the biliary system.
Twenty-five patients with biliary disease and previous sphincterotomy underwent direct TNC.
TNC was successful in 18 of the 25 patients (72%). The procedure revealed 3 common bile duct stones, 4 benign biliary strictures, 1 intraductal adenoma, and 3 cholangiocarcinomas. Eight patients underwent forceps biopsies under direct visualization, and 7 patients underwent therapeutic interventions, including argon plasma coagulation (n = 2), laser lithotripsy (n = 1), stent (n = 1), and stone extraction (n = 3). Other than 1 patient with procedure-related cholangitis, no complications were observed.
Small number of patients and no comparison with conventional cholangioscopy.
One-step TNC with an ultraslim endoscope allows direct visual examination and therapeutic intervention in the bile ducts in the majority of patients with biliary disease. However, development of further accessory instruments will be needed to improve the success rate.
与传统子母镜系统相比，使用超软式内镜直接胆管镜检查具有很大吸引力，因为它提供了一个单人操作平台，具有高分辨率的图像质量，并允许进行先进的治疗干预。然而，胆管进入较为繁琐，通常需要通过逆行胆管造影预先放置导丝。
评估使用超软式内镜和内置球囊的经鼻胆管镜检查（TNC）技术进行 1 步操作的可行性，该技术无需预先放置导丝即可维持胆管进入。
前瞻性、观察性临床可行性研究。
单中心三级转诊中心。
总体手术成功率和并发症。成功的手术定义为内镜可推进至胆管分叉或狭窄段。
25 例胆道疾病且已行括约肌切开术的患者接受直接 TNC。
25 例患者中有 18 例（72%）TNC 成功。该操作发现 3 例胆总管结石、4 例良性胆管狭窄、1 例胆管内腺瘤和 3 例胆管癌。8 例患者在直视下进行了活检钳活检，7 例患者进行了治疗干预，包括氩等离子凝固术（n = 2）、激光碎石术（n = 1）、支架置入术（n = 1）和结石取出术（n = 3）。除 1 例与手术相关的胆管炎外，未观察到其他并发症。
患者数量较少，且未与传统胆管镜检查进行比较。
使用超软式内镜进行 1 步 TNC 可使大多数胆道疾病患者直接进行胆管镜检查和治疗干预。然而，需要开发进一步的辅助器械以提高成功率。
