Ishida Yusuke, Itoi Takao, Okabe Yoshinobu
Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan.
Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku, Tokyo, 160-0023, Japan.
Curr Treat Options Gastroenterol. 2019 Sep;17(3):327-341. doi: 10.1007/s11938-019-00238-1.
With the rapid growth of cholangiopancreatoscopy, several platforms of cholangiopancreatoscopy have been currently available. Since the introduction of digital single-operator cholangiopancreatoscopy, there have been several reports describing its efficacy for long-standing and novel applications. The purpose of this review is to show the current status and future perspective of cholangiopancreatoscopy.
Meta-analysis of cholangiopancreatoscopy have demonstrated good diagnostic yield for visual impression; however, it should be noted that there is no standardized classification system used for distinguishing benign from malignant lesions. In contrast, utility of tissue sampling under direct vision for cholangiopancreatic disorders is inconclusive. This could be explained by the fact that available devices (e.g., biopsy forceps) are limited by the small diameter of accessory channel. Regarding therapeutic applications, several studies demonstrated efficacy and feasibility of electrohydraulic lithotripsy or laser lithotripsy for difficult bile duct stone and pancreatic duct stone under cholangiopancreatoscopic guidance. Additionally, ablation of tumors, selective guidewire placement, retrieval of migrated stents, and anterograde cholangioscopy-guided procedure by using cholangiopancreatoscopy have been reported. The recent development of digital single-operator cholangiopancreatoscopy enables easy access to the bile duct and pancreatic duct, contributing to expanding indications for cholangiopancreatoscopy. Improvement of devices or development of innovative devices is required to overcome the remaining problems of cholangiopancreatoscopy.
随着胰胆管镜检查的迅速发展，目前已有多种胰胆管镜检查平台可供使用。自数字单操作者胰胆管镜检查问世以来，已有多篇报道描述了其在长期应用和新应用中的疗效。本综述的目的是展示胰胆管镜检查的现状和未来前景。
胰胆管镜检查的荟萃分析显示视觉印象的诊断率良好；然而，应当注意的是，目前尚无用于区分良性和恶性病变的标准化分类系统。相比之下，直视下组织采样对胰胆管疾病的效用尚无定论。这可以用现有设备（如活检钳）受辅助通道小直径限制这一事实来解释。关于治疗应用，多项研究证明了在胰胆管镜引导下，电液压碎石术或激光碎石术治疗难取胆管结石和胰管结石的疗效和可行性。此外，还报道了使用胰胆管镜进行肿瘤消融、选择性导丝置入、取出移位支架以及顺行胆管镜引导手术。数字单操作者胰胆管镜检查的最新进展使胆管和胰管的 access 变得容易，有助于扩大胰胆管镜检查的适应症。需要改进设备或开发创新设备以克服胰胆管镜检查的剩余问题。 （注：access 在这里翻译可能不准确，原文可能有误，推测可能是 access 应为 access to，意为“进入、接近”）
