Ogura Takeshi, Miyano Akira, Nishioka Nobu, Higuchi Kazuhide
Dig Dis. 2018;36(6):446-449. doi: 10.1159/000490737. Epub 2018 Aug 28.
Recently, due to improvement of imaging modality, malignant tumor such as pancreatic or bile duct cancer can be detected at earlier stage. Therefore, the frequency of surgical treatment may be increasing. According to this background, benign biliary stricture in anastomosis site may also be increasing. This complication can lead to repeated cholangitis, obstructive jaundice, or liver abscess. Traditionally, interventional radiology such as percutaneous transhepatic biliary drainage (PTCD) or surgical re-anastomosis may be the first choice of treatment for benign biliary stricture in anastomosis site. Recently, double balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography (DB-ERCP) has emerged. This relatively novel procedure has less invasiveness compared with PTCD or surgical re-anastomosis. However, DB-ERCP has also several disadvantages such as long procedure time or low technical success rate if DB-ERCP is performed by non-expert hands. On the other hand, endoscopic ultrasound-guided biliary drainage has been developed as alternative biliary drainage technique. More recently, novel transluminal approach for biliary tract through endoscopic ultrasound-guided transluminal drainage route has been reported using digital single-operator cholangioscope. We herein report technical tips for peroral transluminal cholangioscopy using digital single-operator cholangioscope, and successfully performed recanalization for tight stricture of bile duct-jejunum anastomosis.
近年来，由于成像方式的改进，胰腺癌或胆管癌等恶性肿瘤能够在更早阶段被检测出来。因此，手术治疗的频率可能会增加。基于这一背景，吻合口处的良性胆管狭窄情况可能也在增多。这种并发症可导致反复胆管炎、梗阻性黄疸或肝脓肿。传统上，经皮经肝胆道引流术（PTCD）等介入放射学方法或手术再吻合术可能是吻合口处良性胆管狭窄的首选治疗方法。近年来，双气囊小肠镜辅助内镜逆行胰胆管造影术（DB-ERCP）应运而生。与PTCD或手术再吻合术相比，这种相对新颖的手术侵入性较小。然而，DB-ERCP也有一些缺点，比如操作时间长，如果由非专业人员操作，技术成功率低。另一方面，内镜超声引导下胆道引流术已作为一种替代性胆道引流技术得到发展。最近，有人报道了使用数字单操作者胆管镜通过内镜超声引导的腔内引流途径对胆道采用新的腔内方法。我们在此报告使用数字单操作者胆管镜进行经口腔内胆管镜检查的技术要点，并成功地对胆管空肠吻合口的严重狭窄进行了再通。
