Del Vecchio Blanco Giovanna, Mossa Michelangela, Troncone Edoardo, Argirò Renato, Anderloni Andrea, Repici Alessandro, Paoluzi Omero Alessandro, Monteleone Giovanni
Department of Systems Medicine, Gastroenterology Unit, University of Rome Tor Vergata, Rome 00133, Italy.
Department of Interventional Radiology, University of Rome Tor Vergata, Rome 00133, Italy.
World J Gastrointest Endosc. 2021 Oct 16;13(10):473-490. doi: 10.4253/wjge.v13.i10.473.
Biliary stenosis may represent a diagnostic and therapeutic challenge resulting in a delay in diagnosis and initiation of therapy due to the frequent difficulty in distinguishing a benign from a malignant stricture. In such cases, the diagnostic flowchart includes the sequential execution of imaging techniques, such as magnetic resonance, magnetic resonance cholangiopancreatography, and endoscopic ultrasound, while endoscopic retrograde cholangiopancreatography is performed to collect tissue for histopathological/cytological diagnosis or to treat the stenosis by insertion of stent. The execution of percutaneous transhepatic drainage with subsequent biopsy has been shown to increase the possibility of tissue diagnosis after failure of the above techniques. Although the diagnostic yield of histopathology and imaging has increased with improvements in endoscopic ultrasound and peroral cholangioscopy, differential diagnosis between malignant and benign stenosis may not be easy in some patients, and strictures are classified as indeterminate. In these cases, a multidisciplinary workup including biochemical marker assays and advanced technologies available may speed up a diagnosis of malignancy or avoid unnecessary surgery in the event of a benign stricture. Here, we review recent advancements in the diagnosis and management of biliary strictures and describe tips and tricks to increase diagnostic yields in clinical routine.
胆道狭窄可能是一个诊断和治疗上的挑战，由于常常难以区分良性狭窄和恶性狭窄，会导致诊断延迟和治疗开始时间推迟。在这种情况下，诊断流程图包括依次执行成像技术，如磁共振成像、磁共振胆胰管造影和内镜超声，同时进行内镜逆行胆胰管造影以获取组织进行组织病理学/细胞学诊断，或通过插入支架治疗狭窄。在上述技术失败后，进行经皮经肝胆道引流并随后活检已被证明可增加组织诊断的可能性。尽管随着内镜超声和经口胆管镜检查的改进，组织病理学和成像的诊断率有所提高，但在一些患者中，恶性狭窄和良性狭窄的鉴别诊断可能并不容易，狭窄被归类为不确定。在这些情况下，包括生化标志物检测和可用的先进技术在内的多学科检查可能会加快恶性肿瘤的诊断，或在良性狭窄的情况下避免不必要的手术。在此，我们回顾了胆道狭窄诊断和管理方面的最新进展，并描述了在临床常规中提高诊断率的技巧和窍门。
