Department of Medicine B for Gastroenterology and Hepatology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany.
Surg Endosc. 2019 Mar;33(3):731-737. doi: 10.1007/s00464-018-6334-6. Epub 2018 Jul 13.
Treatment of biliary strictures is challenging. Digital single-operator cholangioscopes (SOCs) equipped with an improved imaging quality, were recently introduced and may be useful for selective guidewire placement in difficult biliary strictures.
A total of 167 digital SOC procedures performed between 2015 and 2018 were retrospectively analyzed for successful guidewire placements across biliary strictures. Only cases with previous failed conventional guidewire placement approaches were included.
In total, 30 examinations with a digital SOC-assisted guidewire placement across biliary strictures, performed in 23 patients, were identified. In 52% of all patients, the stricture was benign with post-liver-transplant strictures (75%) as the most frequent finding; in 48% of all patients the stricture was malignant with cholangiocellular carcinoma as the most frequent type (64%). Guidewire placement was successful in 21 of 30 procedures (70%). According to a subgroup analysis, digital SOC-assisted guidewire placements were significantly more successful in patients with benign strictures than those in patients with malignant strictures (88.2% vs. 46.2%; p = 0.02). Furthermore, the technical success rate tended to be increased in cases of initial examinations (78.3%) than in patients with repeated examinations (42.9%; p = 0.15). Adverse events, such as post-interventional pancreatitis or cholangitis as well as severe bleeding occurred in 16.7% of all examinations.
Digital SOC-assisted guidewire placements have high technical success rates, especially in benign biliary strictures. This technique can help to avoid more invasive procedures such as percutaneous transhepatic or endoscopic ultrasound-guided biliary drainage.
胆道狭窄的治疗具有挑战性。最近引入了配备改良成像质量的单操作数字胆管镜（SOC），对于在困难的胆道狭窄中进行选择性导丝放置可能是有用的。
回顾性分析了 2015 年至 2018 年期间进行的总共 167 例数字 SOC 手术，以评估在胆道狭窄中进行导丝放置的成功率。仅包括先前采用传统导丝放置方法失败的病例。
总共确定了 23 例患者的 30 例数字 SOC 辅助胆道狭窄导丝放置检查。在所有患者中，52%的狭窄为良性，其中肝移植后狭窄（75%）最常见；在所有患者中，48%的狭窄为恶性，其中胆管细胞癌（64%）最常见。在 30 例手术中，21 例（70%）导丝放置成功。根据亚组分析，数字 SOC 辅助导丝放置在良性狭窄患者中明显比恶性狭窄患者更成功（88.2%比 46.2%；p=0.02）。此外，初次检查的技术成功率（78.3%）高于重复检查患者（42.9%；p=0.15）。所有检查中，16.7%的患者发生了介入后胰腺炎或胆管炎以及严重出血等不良事件。
数字 SOC 辅助导丝放置具有较高的技术成功率，尤其是在良性胆道狭窄中。这种技术可以帮助避免更具侵袭性的程序，如经皮经肝或内镜超声引导下胆道引流。
