Fung Brian M, Fejleh M Phillip, Tejaswi Sooraj, Tabibian James H
Department of Medicine, Olive View-UCLA Medical Center, Los Angeles, California, USA.
David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Eur Med J Hepatol. 2020 Jun;8(1):42-53. Epub 2020 Jun 4.
Primary sclerosing cholangitis (PSC) is a cholestatic liver disease characterised by chronic inflammation and fibro-obliteration of the intrahepatic and/or extrahepatic bile ducts. It is associated with numerous hepatobiliary complications including an increased risk of malignancy (in particular, cholangiocarcinoma) and biliary tract stone formation. The evaluation of biliary strictures in patients with PSC is especially challenging, with imaging and endoscopic methods having only modest sensitivity for the diagnosis of cholangiocarcinoma, and treatment of biliary strictures poses a similarly significant clinical challenge. In recent years, peroral cholangioscopy has evolved technologically and increased in popularity as an endoscopic tool that can provide direct intraductal visualisation and facilitate therapeutic manipulation of the biliary tract. However, the indications for and effectiveness of its use in patients with PSC remain uncertain, with only a few studies performed on this small but important subset of patients. In this review, the authors discuss the available data regarding the use of peroral cholangioscopy in patients with PSC, with a focus on its use in the evaluation and management of biliary strictures and stones.
原发性硬化性胆管炎（PSC）是一种胆汁淤积性肝病，其特征为肝内和/或肝外胆管的慢性炎症和纤维闭塞。它与众多肝胆并发症相关，包括恶性肿瘤（尤其是胆管癌）风险增加和胆道结石形成。对PSC患者的胆管狭窄进行评估极具挑战性，成像和内镜检查方法对胆管癌诊断的敏感性仅为中等，胆管狭窄的治疗同样带来重大临床挑战。近年来，经口胆管镜检查技术不断发展，作为一种能够提供直接胆管内可视化并便于胆道治疗操作的内镜工具，其应用日益广泛。然而，其在PSC患者中的使用指征和有效性仍不确定，针对这一虽小但重要的患者亚组开展的研究仅有少数几项。在本综述中，作者讨论了有关经口胆管镜检查在PSC患者中应用的现有数据，重点关注其在胆管狭窄和结石评估及管理中的应用。
