Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore.
Singapore Med J. 2019 Oct;60(10):538-544. doi: 10.11622/smedj.2018158. Epub 2018 Dec 17.
This study examined the efficacy and safety of cholangiopancreatoscopy via the SpyGlass™ system in routine clinical practice.
The clinical data of endoscopic retrograde cholangiopancreatography (ERCP) performed in a regional hospital from January 2013 to November 2016 was retrieved from an electronic database and reviewed. All patients who had undergone SpyGlass cholangiopancreatoscopy were enrolled. Patient demographics, procedure indication, technical success rates, clinical success rates and complication rates were analysed. A subanalysis of clinical outcomes was performed comparing the SpyGlass legacy (fibreoptic) and digital systems.
Out of 2,050 ERCP procedures performed, 47 patients underwent 50 cholangiopancreatoscopy procedures. Clinical indications were difficult common bile duct (CBD) stones (59.6%, n = 28), indeterminate CBD stricture (36.2%, n = 17), indeterminate pancreatic duct stricture (2.1%, n = 1) and proximally migrated CBD stent (2.1%, n = 1). Complete stone extraction was achieved in 26 (92.9%) out of 28 patients. Among patients with strictures, a correct diagnosis of malignancy based on image visualisation was achieved in all 11 cases. The sensitivity and specificity for SpyBite™ biopsies were 81.8% (95% confidence interval [CI] 48.2%-97.7%) and 100.0% (95% CI 15.8%-100.0%), respectively. The proximally migrated CBD stent was successfully extracted. Complications included pancreatitis (2.1%, n = 1), suspected sealed perforation after laser lithotripsy treated conservatively (2.1%, n = 1) and cholangitis (10.6%, n = 5). There was no difference in clinical outcomes between the SpyGlass legacy (n = 20) and digital (n = 30) systems.
SpyGlass cholangiopancreatoscopy is a safe and effective tool in routine clinical practice.
本研究旨在评估经SpyGlass 系统行胆胰管镜检查在常规临床实践中的疗效和安全性。
回顾性分析 2013 年 1 月至 2016 年 11 月期间在一家地区医院进行的内镜逆行胰胆管造影术（ERCP）的临床资料，所有接受SpyGlass 胆胰管镜检查的患者均纳入研究。分析患者的人口统计学资料、操作适应证、技术成功率、临床成功率和并发症发生率。比较 SpyGlass 系统的纤维光学和数字系统的临床结果亚分析。
在 2050 例 ERCP 操作中，47 例患者进行了 50 例胆胰管镜检查。临床适应证为胆总管（CBD）结石困难（59.6%，n=28）、CBD 狭窄原因不明（36.2%，n=17）、胰管狭窄原因不明（2.1%，n=1）和 CBD 支架近端迁移（2.1%，n=1）。28 例患者中，26 例（92.9%）完全取出结石。11 例狭窄患者均通过图像可视化确诊为恶性肿瘤。SpyBite™活检的敏感性和特异性分别为 81.8%（95%置信区间[CI]：48.2%-97.7%）和 100.0%（95%CI：15.8%-100.0%）。成功取出近端 CBD 支架。并发症包括胰腺炎（2.1%，n=1）、激光碎石后疑似封闭性穿孔（2.1%，n=1）和胆管炎（10.6%，n=5）。SpyGlass 系统的纤维光学（n=20）和数字（n=30）系统之间的临床结果无差异。
SpyGlass 胆胰管镜检查在常规临床实践中是一种安全有效的工具。
