Kahaleh Michel, Turner Brian G, Bezak Karl, Sharaiha Reem Z, Sarkaria Savreet, Lieberman Michael, Jamal-Kabani Armeen, Millman Jennifer E, Sundararajan Subha V, Chan Ching, Mehta Shivani, Widmer Jessica L, Gaidhane Monica, Giovannini Marc
Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, United States.
Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, United States.
Dig Liver Dis. 2015 Mar;47(3):202-4. doi: 10.1016/j.dld.2014.11.006. Epub 2014 Nov 13.
Confocal endomicroscopy provides real-time evaluation of various sites and has been used to provide detailed endomicroscopic imaging of the biliary tree. We aimed to evaluate the feasibility and utility of probe-based confocal laser endomicroscopy of the pancreatic duct as compared to cytologic and histologic results in patients with indeterminate pancreatic duct strictures.
Retrospective data on patients with indeterminate pancreatic strictures undergoing endoscopic retrograde cholangiopancreatography (ERCP) and confocal endomicroscopy were collected from two tertiary care centres. Real-time confocal endomicroscopy images were obtained during ERCP and immediate interpretation according to the Miami Classification was performed.
18 patients underwent confocal endomicroscopy for evaluation of pancreatic strictures from July 2011 to December 2012. Mean pancreatic duct size was 4.2mm (range 2.2-8mm). Eight cases were interpreted as benign, 4 as malignant, 4 suggestive of intraductal papillary mucinous neoplasms, and 2 appeared normal. Cytology/histopathology for 15/16 cases showed similar results to confocal endomicroscopy interpretation. Kappa coefficient of agreement between cyto/histopathology and confocal endomicroscopy was 0.8 (p=0.0001). Pancreatic confocal endomicroscopy changed management in four patients, changing the type of surgery from total pancreatectomy to whipple.
Confocal endomicroscopy is effective in assisting with diagnosis of indeterminate pancreatic duct strictures as well as mapping of abnormal pancreatic ducts prior to surgery.
共聚焦内镜可对多个部位进行实时评估，并已用于提供胆管树的详细内镜成像。我们旨在评估与胰腺导管狭窄不确定患者的细胞学和组织学结果相比，基于探头的共聚焦激光内镜检查在胰腺导管中的可行性和实用性。
从两个三级医疗中心收集接受内镜逆行胰胆管造影（ERCP）和共聚焦内镜检查的胰腺狭窄不确定患者的回顾性数据。在ERCP期间获得实时共聚焦内镜图像，并根据迈阿密分类法进行即时解读。
2011年7月至2012年12月，18例患者接受了共聚焦内镜检查以评估胰腺狭窄。胰腺导管平均大小为4.2mm（范围2.2 - 8mm）。8例被解读为良性，4例为恶性，4例提示导管内乳头状黏液性肿瘤，2例显示正常。15/16例的细胞学/组织病理学结果与共聚焦内镜检查解读相似。细胞学/组织病理学与共聚焦内镜检查之间的一致性kappa系数为0.8（p = 0.0001）。胰腺共聚焦内镜检查改变了4例患者的治疗方案，将手术类型从全胰切除术改为惠普尔手术。
共聚焦内镜检查有助于诊断不确定的胰腺导管狭窄，并在手术前对异常胰腺导管进行定位。
