单操作员经口胆道镜在不明原因的胆道病变和胆管结石中的诊断和治疗作用。
Diagnostic and therapeutic utility of single-operator peroral cholangioscopy for indeterminate biliary lesions and bile duct stones.
机构信息
Digestive Diseases Unit, Aintree University Hospital, Liverpool, UK.
出版信息
Eur J Gastroenterol Hepatol. 2012 Jun;24(6):656-64. doi: 10.1097/MEG.0b013e3283526fa1.
BACKGROUND AND AIM
We aimed to evaluate the diagnostic utility of single-operator peroral cholangioscopy (SOC) for indeterminate biliary lesions and its usefulness in electrohydraulic lithotripsy (EHL) of biliary stones not amenable to conventional endoscopic therapy.
PATIENTS AND METHODS
All patients undergoing SpyGlass SOC in four UK tertiary centres between 2008 and 2010 were retrospectively enrolled. Patients were followed up until death or the last clinic visit until May 2011. The operating characteristics of SOC for detecting malignant lesions and the stone clearance rate after SOC-guided EHL were calculated.
RESULTS
A total of 165 patients underwent 179 SOC procedures. Sixty-six percent were referred for indeterminate biliary strictures, 13% for filling defects and 21% for SOC-guided EHL. Cannulation with the SOC system was successful in 95% but visualization was inadequate in 13%. Primary sclerosing cholangitis was a risk factor for failed cannulation and conscious sedation (vs. general anaesthesia) for inadequate visualization (P<0.05). The accuracy of SOC for diagnosing malignant lesions was 87%. SOC-guided biopsies were adequate in 72%. Obtaining at least four versus less than four biopsy specimens resulted more often in adequate samples (90 vs. 64%, P=0.037). Complete stone clearance could be achieved in 73% of patients. The adverse event rate was 9.6%. Cholangitis was the most common event (56%, one fatal).
CONCLUSION
SOC is useful for the differential diagnosis of indeterminate biliary lesions and the treatment of 'difficult' biliary stones. The adequacy of SOC-guided biopsies is related to the number of specimens obtained. Primary sclerosing cholangitis is related to failed cannulation with the SOC system, whereas general anaesthesia is related to adequate visualization.
背景与目的
我们旨在评估单操作员经口胆管镜检查术（SOC）对不确定的胆道病变的诊断效用，及其在无法进行常规内镜治疗的胆道结石的电液压碎石术（EHL）中的应用。
患者与方法
回顾性纳入 2008 年至 2010 年间在英国四个三级中心接受 SpyGlass SOC 的所有患者。患者随访至死亡或直至 2011 年 5 月的最后一次临床就诊。计算 SOC 检测恶性病变的操作特征和 SOC 引导 EHL 后的结石清除率。
结果
共有 165 例患者接受了 179 次 SOC 检查。66%的患者因不确定的胆管狭窄而转介，13%的患者因充盈缺损，21%的患者因 SOC 引导的 EHL 而转介。SOC 系统的插管成功率为 95%，但 13%的患者存在可视化不足的情况。原发性硬化性胆管炎是插管失败的危险因素，而清醒镇静（与全身麻醉相比）是可视化不足的危险因素（P<0.05）。SOC 对诊断恶性病变的准确率为 87%。SOC 引导活检标本充足率为 72%。获得至少 4 个而非少于 4 个活检标本更常获得充足标本（90%比 64%，P=0.037）。73%的患者可实现完全结石清除。不良事件发生率为 9.6%。胆管炎是最常见的事件（56%，其中 1 例为致命性）。
结论
SOC 对不确定的胆道病变的鉴别诊断和“困难”胆道结石的治疗均有帮助。SOC 引导活检标本的充足性与获得的标本数量有关。原发性硬化性胆管炎与 SOC 系统插管失败有关，而全身麻醉与充分可视化有关。
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