Division of Gastroenterology and Hepatology, Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA.
Clin Gastroenterol Hepatol. 2012 May;10(5):466-71; quiz e48. doi: 10.1016/j.cgh.2011.12.021. Epub 2011 Dec 16.
BACKGROUND & AIMS: It is a challenge to collect samples from bile duct strictures to diagnose patients with cholangiocarcinoma. We investigated the utility of the Spyglass Spyscope, a single-operator endoscope that is used to perform cholangiopancreatoscopy, to identify extrahepatic cholangiocarcinoma in patients who were not diagnosed with this disorder by endoscopic retrograde cholangiopancreatography (ERCP) cytology or endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) analyses.
We conducted a retrospective analysis of data from 30 patients (median age, 67 years; 67% male) with indeterminate extrahepatic biliary strictures who were ultimately diagnosed with cholangiocarcinoma but had inconclusive results from initial biliary ductal brush cytology and EUS-FNA analyses. Patients then underwent cholangioscopy by using the Spyglass Spyscope and intraductal biopsy analysis. None of the patients had a definitive mass in abdominal imaging or EUS analyses.
The biliary stricture was located in the common bile duct in 13 patients and in the common hepatic duct in 17 patients. The Spyglass Spyscope system had 77% accuracy (23 of 30) in the diagnosis of malignancies that were inconclusive on the basis of ERCP-guided brush or EUS-FNA analyses.
The Spyglass Spyscope for cholangioscopy and biopsy collection identified malignancies with 77% accuracy in patients with suspected cholangiocarcinoma.
从胆管狭窄处采集样本以诊断胆管癌患者具有挑战性。我们研究了单操作员内窥镜 Spyglass Spyscope 的效用，该内窥镜用于进行胰胆管镜检查，以在通过内镜逆行胰胆管造影术（ERCP）细胞学或内镜超声引导下细针抽吸（EUS-FNA）分析未诊断为该疾病的患者中识别肝外胆管癌。
我们对 30 名（中位年龄 67 岁；男性占 67%）具有不确定的肝外胆管狭窄的患者进行了回顾性数据分析，这些患者最终被诊断为胆管癌，但最初的胆管刷细胞学和 EUS-FNA 分析结果不确定。然后，患者通过使用 Spyglass Spyscope 进行胆管镜检查和胆管内活检分析。这些患者均无腹部影像学或 EUS 分析中存在明确肿块。
13 例患者的胆管狭窄位于胆总管，17 例患者位于肝总管。Spyglass Spyscope 系统在诊断 ERCP 引导下刷检或 EUS-FNA 分析结果不确定的恶性肿瘤方面具有 77%的准确性（23/30）。
在疑似胆管癌患者中，Spyglass Spyscope 进行胆管镜检查和活检采集可准确诊断恶性肿瘤，准确率为 77%。
