经口胆管镜或内镜超声引导下细针抽吸术获取组织用于诊断胆道狭窄。
Tissue acquisition for diagnosis of biliary strictures using peroral cholangioscopy or endoscopic ultrasound-guided fine-needle aspiration.
机构信息
Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon and Seoul, Korea.
Department of Pathology, SoonChunHyang University School of Medicine, Bucheon, Korea.
出版信息
Endoscopy. 2019 Jan;51(1):50-59. doi: 10.1055/a-0645-1395. Epub 2018 Sep 5.
BACKGROUND
Although endoscopic retrograde cholangiopancreatography (ERCP) is a first-line diagnostic modality for suspected malignant biliary stricture (MBS), the diagnostic yield of ERCP-based tissue sampling is insufficient. Peroral cholangioscopy-guided forceps biopsy (POC-FB) and endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB) are evolving as reliable diagnostic procedures for inconclusive MBS. This study aimed to evaluate the usefulness of a diagnostic approach using POC-FB or EUS-FNAB according to the stricture location in patients with suspected MBS.
METHODS
Consecutive patients diagnosed with suspected MBS with obstructive jaundice and/or cholangitis were enrolled prospectively. ERCP with transpapillary forceps biopsy (TPB) was performed initially. When malignancy was not confirmed by TPB, POC-FB using a SpyGlass direct visualization system or direct POC using an ultraslim endoscope was performed for proximal strictures, and EUS-FNAB was performed for distal strictures as a follow-up biopsy.
RESULTS
Among a total of 181 patients, initial TPB showed malignancy in 122 patients, and the diagnostic accuracy of initial TPB was 71.8 % (95 % confidence interval [CI] 65.3 % - 78.4 %]. Of the 59 patients in whom TPB was negative for malignancy, 32 had proximal biliary strictures and underwent successful POC. The remaining 27 patients had distal strictures and underwent successful EUS-FNAB. The accuracy of malignancy detection using POC-FB for proximal biliary strictures and EUS-FNAB for distal biliary strictures was 93.6 % (95 %CI 84.9 %-100 %) and 96.3 % (95 %CI 89.2 %-100 %), respectively. The overall diagnostic accuracy for the combination of TPB with either POC-FB for proximal strictures and EUS-FNAB for distal strictures was 98.3 % (95 %CI 95.9 %-100 %) and 98.4 % (95 %CI 95.3 %-100 %), respectively.
CONCLUSIONS
An approach using POC-FB or EUS-FNAB according to the stricture location may be useful in the diagnosis of suspected MBS.
背景
尽管内镜逆行胰胆管造影术（ERCP）是疑似恶性胆道狭窄（MBS）的一线诊断方法，但基于 ERCP 的组织取样的诊断效果并不理想。经口胆管镜引导活检钳活检（POC-FB）和内镜超声引导细针抽吸活检（EUS-FNAB）是目前诊断不明确的 MBS 的可靠方法。本研究旨在评估根据可疑 MBS 患者的狭窄位置使用 POC-FB 或 EUS-FNAB 的诊断方法的有效性。
方法
连续前瞻性入组诊断为阻塞性黄疸和/或胆管炎伴可疑 MBS 的患者。首先进行 ERCP 联合经乳头活检钳活检（TPB）。如果 TPB 不能明确恶性肿瘤，对于近端狭窄，采用 SpyGlass 直视系统进行 POC-FB 或直接使用超微型内镜进行 POC，对于远端狭窄，进行 EUS-FNAB 作为后续活检。
结果
在总共 181 例患者中，初次 TPB 显示 122 例为恶性肿瘤，初次 TPB 的诊断准确性为 71.8%（95%置信区间 [CI] 65.3%至 78.4%）。在 TPB 为阴性的 59 例患者中，32 例为近端胆道狭窄，成功进行了 POC。其余 27 例为远端胆道狭窄，成功进行了 EUS-FNAB。近端胆道狭窄采用 POC-FB 和远端胆道狭窄采用 EUS-FNAB 的恶性肿瘤检出率分别为 93.6%（95%CI 84.9%至 100%）和 96.3%（95%CI 89.2%至 100%）。TPB 联合近端胆道狭窄的 POC-FB 和远端胆道狭窄的 EUS-FNAB 的总体诊断准确性分别为 98.3%（95%CI 95.9%至 100%）和 98.4%（95%CI 95.3%至 100%）。
结论
根据狭窄位置使用 POC-FB 或 EUS-FNAB 的方法可能有助于诊断可疑的 MBS。
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