Choi Hyun Jong, Moon Jong Ho, Lee Yun Nah, Kim Hyun Su, Ha Ji Su, Lee Tae Hoon, Cha Sang-Woo, Cho Young Deok, Park Sang-Heum
Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon and Seoul, Korea.
Dig Endosc. 2015 Nov;27(7):771-4. doi: 10.1111/den.12481. Epub 2015 Jun 9.
Direct peroral cholangioscopy (POC) using an ultra-slim upper endoscope is one modality of POC for intraductal endoscopic evaluation and treatment of the bile duct. Choledochoduodenostomy (CDS) is one modality of biliary bypass surgery that provides a new route to the bile duct. We carried out direct POC using an ultra-slim upper endoscope without the use of accessories in 10 patients (four sump syndromes, three bile duct strictures and three intrahepatic duct stones) previously undergoing surgical CDS. Direct POC was successful in all patients. The use of an intraductal balloon catheter was required in one patient for advancement of the endoscope into the bile duct. Distal bile ducts with sump syndromes were cleared using baskets and water irrigation under direct POC. Cholangiocarcinoma was diagnosed in one patient with hilar bile duct stricture after cholangioscopic evaluation and a targeting forceps biopsy under direct POC. Intrahepatic duct stones were successfully extracted after intraductal fragmentation under direct POC. Oozing bleeding occurred during intraductal lithotripsy but stopped spontaneously. Direct POC using an ultra-slim upper endoscope without the assistance of accessories can easily be carried out in patients undergoing CDS.
使用超薄上消化道内镜进行直接经口胆管镜检查（POC）是用于胆管内内镜评估和治疗的一种POC方式。胆总管十二指肠吻合术（CDS）是一种胆道旁路手术方式，可为胆管提供一条新路径。我们对10例先前接受过手术CDS的患者（4例胆汁池综合征、3例胆管狭窄和3例肝内胆管结石）使用超薄上消化道内镜进行了不借助附件的直接POC。所有患者的直接POC均成功。1例患者需要使用胆管内球囊导管将内镜推进至胆管。在直接POC下，使用网篮和水冲洗清除了患有胆汁池综合征的远端胆管。在直接POC下进行胆管镜评估和靶向活检钳活检后，1例肝门部胆管狭窄患者被诊断为胆管癌。在直接POC下进行胆管内碎石后，成功取出了肝内胆管结石。胆管内碎石过程中出现渗血，但自行停止。在接受CDS的患者中，可以轻松地在不借助附件的情况下使用超薄上消化道内镜进行直接POC。
