Inoue Tadahisa, Kitano Rena, Kobayashi Yuji, Ishii Norimitsu, Sakamoto Kazumasa, Ohashi Tomohiko, Nakade Yukiomi, Sumida Yoshio, Ito Kiyoaki, Nakao Haruhisa, Yoneda Masashi
a Department of Gastroenterology , Aichi Medical University School of Medicine , Nagakute , Japan.
Scand J Gastroenterol. 2018 May;53(5):598-603. doi: 10.1080/00365521.2017.1409799. Epub 2017 Nov 28.
Biliary forceps biopsies are essential for differentially diagnosing biliary strictures and evaluating the preoperative superficial intraductal spread of bile duct cancers; however, these biopsies are technically demanding and time consuming. Using controllable biopsy-forceps (C-BF), which enable the tip's angle to be adjusted by up to 90°, may facilitate the procedure and improve the diagnostic yield for biliary biopsies. This study aimed to examine the efficacy of C-BF associated with the diagnosis of biliary strictures.
Between 2009 and 2015, 110 patients with biliary strictures underwent biliary biopsies using C-BF. We retrospectively evaluated the diagnostic yield of C-BF for biliary strictures and determined the success rate associated with obtaining adequate samples during mapping biopsies to evaluate the superficial intraductal tumor spread.
The technical success rate for biliary biopsies using C-BF was 99% (109/110). The sensitivity, specificity and accuracy of the diagnoses of biliary strictures were 60% (46/77), 100% (33/33) and 72% (79/110), respectively. Regarding the mapping biopsy procedures, adequate samples were successfully obtained from 96% (22/23), 92% (11/12), 80% (12/15), 75% (9/12) and 31% (5/16) of the intrapancreatic common bile ducts, upper common bile ducts, confluences of the hepatic ducts, right intrahepatic bile ducts and left intrahepatic bile ducts, respectively.
C-BF may facilitate biliary cannulation and mapping biopsies of the common bile duct and the right intrahepatic bile duct. However, given that the diagnostic sensitivity was 60%, further modifications are expected and necessary to maximize the utility of the controllable mechanism.
胆管钳活检对于鉴别诊断胆管狭窄及评估胆管癌术前导管内表面扩散至关重要；然而，这些活检技术要求高且耗时。使用可控活检钳（C-BF），其尖端角度可调节达90°，可能会使该操作更简便，并提高胆管活检的诊断率。本研究旨在探讨C-BF在胆管狭窄诊断中的疗效。
2009年至2015年期间，110例胆管狭窄患者使用C-BF进行了胆管活检。我们回顾性评估了C-BF对胆管狭窄的诊断率，并确定了在进行测绘活检以评估导管内表面肿瘤扩散时获取足够样本的成功率。
使用C-BF进行胆管活检的技术成功率为99%（109/110）。胆管狭窄诊断的敏感性、特异性和准确性分别为60%（46/77）、100%（33/33）和72%（79/110）。关于测绘活检程序，分别从96%（22/23）、92%（11/12）、80%（12/15）、75%（9/12）和31%（5/16）的胰内胆总管、肝上胆总管、肝管汇合处、右肝内胆管和左肝内胆管成功获取了足够的样本。
C-BF可能有助于胆管插管以及胆总管和右肝内胆管的测绘活检。然而，鉴于诊断敏感性为60%，需要进一步改进并很有必要最大化可控机制的效用。
