Tanisaka Yuki, Mizuide Masafumi, Fujita Akashi, Ogawa Tomoya, Suzuki Masahiro, Katsuda Hiromune, Saito Youichi, Miyaguchi Kazuya, Tashima Tomoaki, Mashimo Yumi, Ryozawa Shomei
Department of Gastroenterology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan.
J Clin Med. 2021 Mar 3;10(5):1048. doi: 10.3390/jcm10051048.
The diagnostic process for biliary strictures remains challenging in some cases. A broad differential diagnosis exists for indeterminate biliary strictures, including benign or malignant lesions. The diagnosis of indeterminate biliary strictures requires a combination of physical examination, laboratory testing, imaging modalities, and endoscopic procedures. Despite the progress of less invasive imaging modalities such as transabdominal ultrasonography, computed tomography, and magnetic resonance imaging, endoscopy plays an essential role in the accurate diagnosis, including the histological diagnosis. Imaging findings and brush cytology and/or forceps biopsy under fluoroscopic guidance with endoscopic retrograde cholangiopancreatography (ERCP) are widely used as the gold standard for the diagnosis of biliary strictures. However, ERCP cannot provide an intraluminal view of the biliary lesion, and its outcomes are not satisfactory. Recently, peroral cholangioscopy, confocal laser endomicroscopy, endoscopic ultrasound (EUS), and EUS-guided fine-needle aspiration have been reported as useful for indeterminate biliary strictures. Appropriate endoscopic modalities need to be selected according to the patient's condition, the lesion, and the expertise of the endoscopist. The aim of this review article is to discuss the diagnostic process for indeterminate biliary strictures using endoscopy.
在某些情况下，胆管狭窄的诊断过程仍然具有挑战性。对于不确定的胆管狭窄存在广泛的鉴别诊断，包括良性或恶性病变。不确定胆管狭窄的诊断需要结合体格检查、实验室检查、影像学检查和内镜检查。尽管诸如经腹超声、计算机断层扫描和磁共振成像等微创影像学检查取得了进展，但内镜检查在准确诊断（包括组织学诊断）中起着至关重要的作用。影像学表现以及在荧光透视引导下经内镜逆行胰胆管造影（ERCP）进行的刷检细胞学检查和/或钳取活检被广泛用作胆管狭窄诊断的金标准。然而，ERCP无法提供胆管病变的腔内视图，其诊断结果并不令人满意。最近，经口胆管镜检查、共聚焦激光显微内镜检查、内镜超声（EUS）以及EUS引导下细针穿刺抽吸已被报道对不确定的胆管狭窄有用。需要根据患者的病情、病变情况以及内镜医师的专业技能选择合适的内镜检查方式。本文综述的目的是讨论使用内镜检查对不确定胆管狭窄的诊断过程。
