Digestive Disease Center and Research Institute, Departments of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon, Cheonan, and Seoul, Korea.
Pathology, SoonChunHyang University School of Medicine, Bucheon, Cheonan, and Seoul, Korea.
Gastrointest Endosc. 2021 Oct;94(4):776-785. doi: 10.1016/j.gie.2021.03.997. Epub 2021 Apr 15.
Although cholangiocarcinomas (CCAs) can be diagnosed using several modalities, the detection of early-stage cancers remains unsatisfactory. We explored whether peroral cholangioscopy (POC) could be used to screen for neoplastic bile duct lesions including CCAs in patients with bile duct stones.
Two hundred seven patients who underwent endoscopic removal of bile duct stones were enrolled between August 2010 and July 2018. The primary outcome was the detection rate of intraductal neoplastic biliary lesions by direct POC. Secondary outcomes were the technical success rates of direct POC and POC-guided forceps biopsy sampling (POC-FB), the diagnostic accuracy of the direct POC findings, adverse events, and the number needed to screen to detect a neoplastic bile duct lesion.
Direct POC was successful in 199 of 207 patients (96.1%). Mild cholangitis developed in 2 patients (1.0%) and was treated conservatively. Of the 199 successfully performed POCs, 31 patients (15.6%) exhibited abnormal intraductal mucosal lesions. The technical success rate of POC-FB was 90.3% (28/31 patients). The pathologic diagnoses after POC-FB were CCAs (n = 4), intraductal papillary neoplasms of the bile duct (IPN-B) (n = 2), an adenoma with dysplasia (n = 1), and benign lesions (n = 21). Direct POC correctly distinguished non-neoplastic from neoplastic bile duct lesions in 91.6% of patients. Curative surgical resection was performed for the 5 patients with CCAs or IPN-B. The number needed to screen to detect a neoplastic bile duct lesion was 29.6.
Direct POC using a dedicated, ultraslim upper endoscope usefully screens for neoplastic bile duct lesions including CCAs in selected patients with bile duct stones.
尽管胆管癌（CCA）可以通过多种方式诊断，但早期癌症的检测仍不尽如人意。我们探讨了经口胆管镜（POC）是否可用于筛查包括胆管结石患者在内的有肿瘤性胆管病变。
2010 年 8 月至 2018 年 7 月期间，我们共纳入了 207 例行内镜取石术的胆管结石患者。主要结局是直接 POC 对管内肿瘤性胆管病变的检出率。次要结局是直接 POC 和 POC 引导下活检钳取样（POC-FB）的技术成功率、直接 POC 结果的诊断准确性、不良事件和筛查发现肿瘤性胆管病变的数量。
207 例患者中，199 例（96.1%）成功进行了直接 POC。2 例（1.0%）患者出现轻度胆管炎，经保守治疗治愈。在 199 例成功进行的 POC 中，31 例（15.6%）患者表现出异常的胆管内黏膜病变。POC-FB 的技术成功率为 90.3%（31 例患者中的 28 例）。POC-FB 后的病理诊断为 CCA（n=4）、胆管内乳头状肿瘤（IPN-B）（n=2）、腺瘤伴异型增生（n=1）和良性病变（n=21）。直接 POC 正确区分了非肿瘤性和肿瘤性胆管病变，准确率为 91.6%。5 例 CCA 或 IPN-B 患者行根治性手术切除。筛查发现肿瘤性胆管病变的数量需要 29.6 例。
在选择的胆管结石患者中，使用专用的超纤细内镜进行直接 POC 可有效筛查包括 CCA 在内的肿瘤性胆管病变。
