经内镜乳头括约肌小切开术在胆总管探查术中的应用
Efficacy of cap-assisted endoscopy for routine examining the ampulla of Vater.
机构信息
Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju 361-711, South Korea.
出版信息
World J Gastroenterol. 2013 Apr 7;19(13):2037-43. doi: 10.3748/wjg.v19.i13.2037.
AIM
To determine the efficacy of a cap-assisted endoscopy (CAE) to completely visualize the ampulla of Vater (AV) in patients failed by conventional endoscopy.
METHODS
A prospective study was conducted on 120 patients > 20 years of ages who visited the Health Promotion Center of Chungbuk National University Hospital for conscious sedation esophagogastroduodenoscopy (EGD) as a screening test from July to October, 2011. First, forward-viewing endoscopy was performed with reasonable effort using a push and pull method. We considered complete visualization of the AV when we could observe the entire AV including the orifice clearly, and reported the observation as complete or incomplete (partial or not found at all). Second, in cases of complete failure of the observation, an additional AV examination was conducted by attaching a short cap (D-201-10704, Olympus Medical Systems, Tokyo, Japan) to the tip of a forward-viewing endoscope. Third, if the second method failed, we replaced the short cap with a long cap (MH-593, Olympus Medical Systems) and performed a re-examination of the AV.
RESULTS
Conventional endoscopy achieved complete visualization of the AV in 97 of the 120 patients (80.8%) but was not achieved in 23 patients (19.2%). Age (mean ± SD) and gender [male (%)] were not significantly different between the complete observation and the incomplete observation groups. Additional short CAE was performed in patients in whom we could not completely visualize the AV. This group included 13 patients (10.9%) with partial observation of the AV and 10 (8.3%) in which the AV was not found. Short CAE permitted a complete observation of the AV in 21 of the 23 patients (91.3%). Patients in whom visualization of the AV failed with short CAE had satisfactory outcomes by replacing the short cap with a long cap. The additional time for CAE took an average of 141 ± 88 s. There were no complications and no significant mucosal trauma.
CONCLUSION
CAE is safe to use as a salvage method to achieve complete visualization of the AV when a regular EGD examination fails.
目的
确定帽辅助内镜（CAE）在常规内镜检查失败的患者中完全观察 Vater 壶腹（AV）的疗效。
方法
对 2011 年 7 月至 10 月期间因清醒镇静食管胃十二指肠镜检查（EGD）作为筛查试验前往忠北国立大学医院健康促进中心就诊的 120 名> 20 岁的患者进行了一项前瞻性研究。首先，使用推拉法进行前视内镜检查，并进行合理努力。当我们能够清楚地观察到整个 AV 包括开口时，我们认为完全观察到 AV，并且将观察结果报告为完全或不完全（部分或根本未发现）。其次，在观察完全失败的情况下，通过将短帽（D-201-10704，Olympus Medical Systems，东京，日本）附加到前视内镜的尖端进行额外的 AV 检查。第三，如果第二种方法失败，我们用长帽（MH-593，Olympus Medical Systems）替换短帽，并重新检查 AV。
结果
120 例患者中，常规内镜检查 97 例（80.8%）完全观察到 AV，但 23 例（19.2%）未观察到。完全观察组和不完全观察组的年龄（平均值±标准差）和性别[男性（%）]无显著差异。在我们无法完全观察 AV 的患者中进行了额外的短 CAE。该组包括 13 例（10.9%）部分观察到 AV 和 10 例（8.3%）未发现 AV。短 CAE 使 23 例患者中的 21 例（91.3%）能够完全观察到 AV。在短 CAE 下观察 AV 失败的患者，通过更换短帽，结果令人满意。CAE 的额外时间平均为 141±88 秒。无并发症，无明显黏膜损伤。
结论
当常规 EGD 检查失败时，CAE 是一种安全的补救方法，可用于实现 AV 的完全观察。
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