Oleas Roberto, Alcívar-Vasquez Juan, Robles-Medranda Carlos
Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador.
Transl Gastroenterol Hepatol. 2022 Apr 25;7:22. doi: 10.21037/tgh.2020.03.05. eCollection 2022.
An early and accurate diagnosis of biliary strictures yields optimal patient outcomes; however, endoscopic retrograde cholangiopancreatography (ERCP) with cytobrush/biopsy forceps has low sensitivity with a high number of false negatives. Various attempts to improve the accuracy of diagnosing indeterminate biliary strictures though ERCP-guided specimen acquisition have been proposed, such as with the use of fluorescence in situ hybridization, an endoscopic scraper, and the wire-grasping method, with modest to large improvements in sensitivity. Direct visualization of the biliary tree during peroral cholangioscopy has shown high sensitivity and specificity for the differentiation of neoplastic and non-neoplastic biliary lesions; however, there is no consensus on the visual characteristics of neoplastic lesions and moderate agreement between observers. Peroral cholangioscopy system (POCS)-guided specimen acquisition using forceps has shown inferior sensitivity compared to the visual characteristics; however, the specificity remains high. Optimal specimen processing with onsite evaluations and touch imprint cytology have been shown to improve the sensitivity and accurately diagnose nearly 90% of patients. evaluations of biliary strictures with probe-based confocal laser endomicroscopy have demonstrated high sensitivity with modest specificity for malignant biliary strictures. Optical computed tomography described reproductible criteria for malignancy detection in biliary strictures, increasing the sensitivity during ERCP evaluations. Differentiating benign causes from malignant causes of biliary strictures is a challenging task in clinical practice, with various concerns that still need to be addressed. Efforts should be made to define each diagnostic method's role in the evaluation of indeterminate biliary strictures.
早期准确诊断胆管狭窄可使患者获得最佳治疗效果；然而，使用细胞刷/活检钳的内镜逆行胰胆管造影（ERCP）敏感性较低，假阴性率较高。人们提出了各种通过ERCP引导下获取标本以提高诊断不明确胆管狭窄准确性的尝试，例如使用荧光原位杂交、内镜刮匙和钢丝抓取法，敏感性有适度到大幅提高。经口胆管镜检查时对胆管树的直接观察显示，其对肿瘤性和非肿瘤性胆管病变的鉴别具有较高的敏感性和特异性；然而，对于肿瘤性病变的视觉特征尚无共识，观察者之间的一致性一般。与视觉特征相比，使用钳子在经口胆管镜系统（POCS）引导下获取标本的敏感性较低；然而，特异性仍然较高。现场评估和触摸印片细胞学检查等最佳标本处理方法已被证明可提高敏感性，并能准确诊断近90%的患者。基于探头的共聚焦激光内镜检查对胆管狭窄的评估显示，对恶性胆管狭窄具有较高的敏感性和适度的特异性。光学计算机断层扫描描述了胆管狭窄恶性病变检测的可重复标准，提高了ERCP评估期间的敏感性。在临床实践中，区分胆管狭窄的良性病因和恶性病因是一项具有挑战性的任务，仍有各种问题需要解决。应努力确定每种诊断方法在评估不明确胆管狭窄中的作用。
