Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Department of Research Affairs, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Endoscopy. 2020 Mar;52(3):174-185. doi: 10.1055/a-1083-6105. Epub 2020 Jan 10.
Cholangioscopy provides direct intraductual imaging, which can enhance diagnostic efficacy during endoscopic retrograde cholangiopancreatography in patients with biliary strictures. This study aimed to review the diagnostic yield of different cholangioscopes for the diagnosis of malignant biliary stricture (MBS).
A comprehensive literature review was performed. Full papers of prospective studies using any type of peroral cholangioscope (POC) were included without language restriction. The primary outcomes were sensitivity, specificity, and accuracy of various POCs to diagnose MBS.
Data from 20 published articles, involving 1141 patients, were extracted. Overall sensitivities of POCs for diagnosing MBS were higher for the diagnosis made under visual impression compared with those from cholangioscopy-guided biopsy (67 % - 100 % vs. 38 % - 100 %), whereas the overall specificities were generally high and comparable (73 % - 100 % vs. 75 % - 100 %). Newer video cholangioscopes (digital single-operator POC [digital SOC], direct POC) with the exception of video dual-operator mother - baby POC (video DOC), provided better sensitivity of cholangioscopy-guided biopsy compared with fiberoptic scopes (digital SOC 80 % - 85 %, direct POC 80 % - 100 %, video DOC 38 % - 100 %, and fiberoptic SOC 49 % - 100 %, respectively). Among these video cholangioscopes, the digital SOC provided the highest technical success rate, at 100 %.
POCs enhanced the diagnostic yield for diagnosis of MBS. Compared with fiberoptic POCs that only provide good image impression, the digital SOC and direct POC were good at both image impression and cholangioscopy-guided biopsy to diagnose MBS. To ensure high technical success for MBS diagnosis, the digital SOC is a good option.
胆管镜提供直接的胆管内成像，可提高内镜逆行胰胆管造影术（ERCP）中胆道狭窄患者的诊断效果。本研究旨在回顾不同胆管镜对恶性胆道狭窄（MBS）的诊断效能。
进行全面的文献回顾。纳入了使用任何类型经口胆管镜（POC）的前瞻性研究的全文，无语言限制。主要结局是各种 POC 诊断 MBS 的敏感度、特异度和准确度。
提取了 20 篇已发表文献的数据，共涉及 1141 例患者。与胆管镜引导下活检相比，POC 对 MBS 的诊断基于视觉印象的总体敏感度更高（67%–100% vs. 38%–100%），而总体特异度通常较高且相似（73%–100% vs. 75%–100%）。除视频双操作子母镜（video DOC）外，新型视频胆管镜（数字单操作 POC[数字 SOC]、直接 POC）在胆管镜引导下活检的诊断效能优于纤维胆管镜（数字 SOC 80%–85%、直接 POC 80%–100%、video DOC 38%–100%和纤维 SOC 49%–100%）。在这些视频胆管镜中，数字 SOC 的技术成功率最高，为 100%。
POC 提高了 MBS 的诊断效能。与仅提供良好图像印象的纤维 POC 相比，数字 SOC 和直接 POC 既擅长图像印象，也擅长胆管镜引导下活检，可用于诊断 MBS。为了确保 MBS 诊断的高技术成功率，数字 SOC 是一个不错的选择。
