Lourdusamy Vennisvasanth, Tharian Benjamin, Navaneethan Udayakumar
Vennisvasanth Lourdusamy, Benjamin Tharian, Udayakumar Navaneethan, Center for Interventional Endoscopy, Institute for Minimally Invasive Surgery, Florida Hospital, Orlando, FL 32803, United States.
World J Gastrointest Endosc. 2015 Apr 16;7(4):308-17. doi: 10.4253/wjge.v7.i4.308.
Biliary strictures present a diagnostic challenge and a conundrum, particularly when an initial work up including abdominal imaging and endoscopic retrograde cholangiopancreatography based sampling are non-diagnostic. Advances in endoscopic imaging have helped us diagnose these strictures better. However, even with modern technology, some strictures remain a diagnostic challenge. The proximity of bile fluid to the bile duct epithelia makes it an attractive option to investigate for bio-markers, which might be representative of the functions/abnormal changes taking place in the biliary system. A number of biomarkers in bile have been discovered recently in approaching biliary strictures with their potential future diagnostic utility, further supported by the immunohistochemical analysis of the resected tissue specimens. Novel biliary biomarkers especially carcinoembryonic cell adhesion molecule 6 and neutrophil gelatinase-associated lipocalin seem promising in differentiating malignant from benign biliary strictures. Recent developments in lipidomic profiling of bile are also very promising. Biliary biomarkers appear to complement endoscopic imaging in diagnosing malignant etiologies of biliary stricture. Future studies addressing these biomarkers need to be incorporated to the current endoscopic techniques to determine the best approach in determining the etiology of biliary strictures.
胆管狭窄带来了诊断挑战和难题，尤其是当包括腹部影像学检查和基于内镜逆行胰胆管造影的采样在内的初步检查无法确诊时。内镜成像技术的进步有助于我们更好地诊断这些狭窄。然而，即使采用现代技术，一些狭窄仍然是诊断上的挑战。胆汁与胆管上皮细胞的接近性使得研究生物标志物成为一个有吸引力的选择，这些生物标志物可能代表胆管系统中发生的功能/异常变化。最近，在探讨胆管狭窄时发现了胆汁中的一些生物标志物及其潜在的未来诊断用途，切除组织标本的免疫组织化学分析进一步支持了这一点。新型胆管生物标志物，特别是癌胚细胞粘附分子6和中性粒细胞明胶酶相关脂质运载蛋白，在区分恶性和良性胆管狭窄方面似乎很有前景。胆汁脂质组学分析的最新进展也非常有前景。胆管生物标志物似乎可以补充内镜成像在诊断胆管狭窄恶性病因方面的作用。未来针对这些生物标志物的研究需要纳入当前的内镜技术，以确定确定胆管狭窄病因的最佳方法。
