Tripathi Nishant, Mardini Houssam, Koirala Niki, Raissi Driss, Emhmed Ali Saad M, Frandah Wesam M
Division of Hospital Medicine, Department of Internal Medicine, University of Kentucky, Lexington, Kentucky, KY, USA.
Division of Gastroenterology, Department of Internal Medicine, University of Kentucky, Lexington, Kentucky, KY, USA.
Transl Gastroenterol Hepatol. 2020 Jan 5;5:12. doi: 10.21037/tgh.2019.11.11. eCollection 2020.
Bile duct stones, indeterminate biliary strictures and other biliary duct pathologies represent a significant surgical and endoscopic challenge in patients with altered luminal or biliary anatomy. Traditional endoscopic retrograde cholangiopancreatography (ERCP) is not feasible and alternative approach is usually required. A novel alternative approach of addressing these challenging cases is assessed by this case series. All patients who underwent percutaneous transhepatic cholangioscopy (PTCS) and Spyglass Direct visualization system (SDVS) between December 2016 and February 2018 were studied. The indications for procedure, interventions performed, outcomes and complications were reviewed for each case. Spyglass marketed by Boston Scientific Corporation, Marlborough, Massachusetts was utilized by interventional endoscopists and radiologists through a 12 French (Fr) percutaneous vascular sheath. Five patients had altered biliary and/or luminal anatomy: two with Roux-en-Y gastric bypass and three with Roux-en-Y hepaticojejunostomy. All patients had unsuccessful previous ERCP attempts. All PTCS with SDVS procedures were technically successful. Indications for this unusual approach were: ascending cholangitis, abnormal liver function tests and biliary dilation on imaging. SDVS was utilized to conduct electrohydraulic lithotripsy (EHL) for biliary stone management in four patients and intraductal biopsies for indeterminate strictures in two of them. PTCS with SDVS can be beneficial for multiple diagnostic and therapeutic indications in patients with altered biliary or luminal anatomy. SDVS allows direct evaluation and management of different biliary pathologies in challenging cases where traditional ERCP is not feasible. Some indications for PTCS with SDVS include evaluation of biliary strictures and biliary stasis, biliary tract biopsy and lithotripsy for management of biliary stones.
胆管结石、不明原因的胆管狭窄及其他胆管病变，对于管腔或胆管解剖结构改变的患者而言，是外科手术和内镜治疗面临的重大挑战。传统的内镜逆行胰胆管造影（ERCP）不可行，通常需要采用替代方法。本病例系列评估了一种处理这些具有挑战性病例的新型替代方法。研究了2016年12月至2018年2月期间所有接受经皮经肝胆道镜检查（PTCS）和Spyglass直视系统（SDVS）的患者。回顾了每个病例的手术指征、所进行的干预措施、结果及并发症。马萨诸塞州马尔伯勒市的波士顿科学公司销售的Spyglass，由介入内镜医师和放射科医生通过一个12法式（Fr）的经皮血管鞘使用。5例患者存在胆管和/或管腔解剖结构改变：2例为 Roux-en-Y胃旁路术，3例为 Roux-en-Y肝空肠吻合术。所有患者之前的ERCP尝试均未成功。所有PTCS联合SDVS手术在技术上均获成功。采用这种特殊方法的指征包括：化脓性胆管炎、肝功能检查异常及影像学检查显示胆管扩张。4例患者使用SDVS进行了电液压碎石术（EHL）以处理胆管结石，其中2例对不明原因的狭窄进行了胆管内活检。PTCS联合SDVS对于胆管或管腔解剖结构改变的患者在多种诊断和治疗指征方面可能有益。在传统ERCP不可行的具有挑战性的病例中，SDVS可对不同的胆管病变进行直接评估和处理。PTCS联合SDVS的一些指征包括评估胆管狭窄和胆汁淤积、胆管活检以及处理胆管结石的碎石术。
