Department of Gastroenterology, Skåne University Hospital, Lund, Sweden.
Curr Opin Gastroenterol. 2012 May;28(3):273-9. doi: 10.1097/MOG.0b013e328351436e.
Endoscopic diagnosis of biliary disease is challenging due to difficulties in access, visualization, and sampling. Recent advances in endoscopic technology, ancillary diagnostic methods, and our understanding of autoimmune pancreatitis (AIP) and IgG4-related cholangitis (IRC) have led to improvements in the endoscopic diagnosis of pancreaticobiliary disease.
Single-operator cholangioscopy overcomes several of the limitations of mother-baby cholangioscopy enhancing the diagnostic accuracy in indeterminate pancreaticobiliary disease. Probe-based confocal laser endomicroscopy has been recently shown to provide a significantly higher accuracy for the diagnosis of malignant biliary strictures than achieved by endoscopic retrograde cholangiopancreatogram and standard tissue acquisition, and has the potential to develop into a useful adjunct method of cholangioscopy. Fluorescence in-situ hybridization increases the sensitivity of routine brush cytology without compromising specificity in patients with indeterminate biliary strictures. The diagnosis of AIP/IRC remains challenging. The recently published international consensus criteria for AIP have included data on the potential diagnostic utility of endoscopic retrograde pancreatogram and endoscopic ampullary biopsies.
Recent technical advances as well as ancillary diagnostic methods have improved the diagnostic accuracy of conventional endoscopic techniques. Future refinement of endoscopic methods may further improve diagnostic approaches to biliary disease.
目的综述：由于胆道疾病的内镜诊断存在检查通道、可视度和取样困难等问题，因此极具挑战性。近年来，内镜技术、辅助诊断方法以及对自身免疫性胰腺炎（AIP）和 IgG4 相关胆管炎（IRC）的认识的进步，使胰胆管疾病的内镜诊断得到了改善。
最新发现：单人操作胆管镜克服了子母胆管镜的一些局限性，提高了不明原因胰胆管疾病的诊断准确性。最近的研究表明，与内镜逆行胰胆管造影术和标准组织采集相比，基于探头的共聚焦激光内镜检查术在诊断恶性胆道狭窄方面具有更高的准确性，有可能成为胆管镜检查的一种有用的辅助方法。荧光原位杂交在不影响不明原因胆道狭窄患者特异性的情况下，提高了常规刷检细胞学的敏感性。AIP/IRC 的诊断仍然具有挑战性。最近公布的 AIP 国际共识标准纳入了有关内镜逆行胰胆管造影术和内镜壶腹活检术潜在诊断效用的数据。
总结：最近的技术进步以及辅助诊断方法提高了常规内镜技术的诊断准确性。内镜方法的进一步完善可能会进一步改进胆道疾病的诊断方法。
