Williamson J B, Draganov P V
University of Florida College of Medicine, PO Box 100214, 1600 SW Archer Rd, Gainesville, FL 32610, USA.
Curr Gastroenterol Rep. 2012 Dec;14(6):534-41. doi: 10.1007/s11894-012-0287-z.
Peroral choledochoscopy was first described in the 1970s, but the use of earlier generation choledochoscopes was significantly limited by complex equipment setup and fragility resulting in high repair costs. In late 2006, the SpyGlass Direct Visualization System (Boston Scientific Corp, Natick, MA, USA) was introduced to the market. It is a single-operator cholangioscopy platform and improves upon many shortcomings of the dual-operator systems. Currently, the two main indications for its use are evaluation of indeterminate biliary strictures and lithotripsy for difficult-to-remove biliary stones. Recently published prospective data reconfirm that the overall success rates for adequate tissue sampling and bile duct stone clearance are around 90 %, with an acceptable safety profile. The sensitivity for detecting cancer in intrinsic biliary strictures (e.g., cholangiocarcinoma) is superior to that of standard ERCP sampling modalities, but a limited yield has been noted when sampling extrinsic malignant biliary strictures (e.g., pancreatic cancer). The two main limitations of the SpyGlass system are image quality that is impeded by the use of fiberoptic technology and a relatively small accessory channel providing passage only for dedicated miniaccessories. Nevertheless, the SpyGlass platform has made single-operator cholangioscopy feasible and refined the technique in a number of important ways. This innovation has significantly expanded our diagnostic and therapeutic ERCP armamentarium. An upgraded digital imaging version is currently in development.
经口胆管镜检查最早于20世纪70年代被描述，但早期一代胆管镜的使用因设备设置复杂和易碎导致维修成本高昂而受到显著限制。2006年末，SpyGlass直视系统（美国马萨诸塞州纳蒂克市波士顿科学公司）推向市场。它是一个单人操作的胆管镜检查平台，改进了双人操作系统的许多缺点。目前，其使用的两个主要适应证是评估不明原因的胆管狭窄和对难以取出的胆管结石进行碎石术。最近发表的前瞻性数据再次证实，充分组织采样和胆管结石清除的总体成功率约为90%，安全性可接受。检测胆管内源性狭窄（如胆管癌）中癌症的敏感性优于标准内镜逆行胰胆管造影（ERCP）采样方式，但在对胆管外源性恶性狭窄（如胰腺癌）进行采样时，检出率有限。SpyGlass系统的两个主要局限性是图像质量受光纤技术使用的影响，以及辅助通道相对较小，仅能为专用微型附件提供通道。尽管如此，SpyGlass平台使单人操作胆管镜检查变得可行，并在许多重要方面改进了该技术。这一创新显著扩展了我们诊断和治疗性ERCP的手段。目前正在开发升级版的数字成像版本。
