Department of Medicine B (Gastroenterology, Hepatology, Endocrinology, Clinical Infectiology), University Hospital Muenster, Muenster 48149, Germany.
Department of Gastroenterology, Hepatology and Transplant Medicine, University Hospital Essen, Essen 45147, Germany.
World J Gastroenterol. 2022 May 28;28(20):2201-2213. doi: 10.3748/wjg.v28.i20.2201.
Patients with primary sclerosing cholangitis (PSC) are at a high risk of developing cholestatic liver disease and biliary cancer, and endoscopy is crucial for the complex management of these patients.
To clarify the utility of recently introduced digital single-operator video cholangioscopy (SOVC) for the endoscopic management of PSC patients.
In this observational study, all patients with a history of PSC and in whom digital SOVC (using the SpyGlass DS System) was performed between 2015 and 2019 were included and retrospectively analysed. Examinations were performed at a tertiary referral centre in Germany. In total, 46 SOVCs performed in 38 patients with a history of PSC were identified. The primary endpoint was the evaluation of dominant biliary strictures using digital SOVC, and the secondary endpoints were the performance of selective guidewire passage across biliary strictures and the diagnosis and treatment of biliary stone disease in PSC patients.
The 22 of 38 patients had a dominant biliary stricture (57.9%). In 4 of these 22 patients, a cholangiocellular carcinoma was diagnosed within the stricture (18.2%). Diagnostic evaluation of dominant biliary strictures using optical signs showed a sensitivity of 75% and a specificity of 94.4% to detect malignant strictures, whereas SOVC-guided biopsies to gain tissue for histopathological analysis showed a sensitivity of 50% and a specificity of 100%. In 13% of examinations, SOVC was helpful for guidewire passage across biliary strictures that could not be passed by conventional methods (technical success rate 100%). Biliary stone disease was observed in 17.4% of examinations; of these, in 37.5% of examinations, biliary stones could only be visualized by SOVC and not by standard fluoroscopy. Biliary stone treatment was successful in all cases (100%); 25% required SOVC-assisted electrohydraulic lithotripsy. Complications, such as postinterventional cholangitis and pancreatitis, occurred in 13% of examinations; however, no procedure-associated mortality occurred.
Digital SOVC is effective and safe for the endoscopic management of PSC patients and may be regularly considered an additive tool for the complex endoscopic management of these patients.
原发性硬化性胆管炎（PSC）患者发生胆汁淤积性肝病和胆道癌的风险较高，内镜检查对于这些患者的复杂管理至关重要。
阐明最近引入的数字单操作器视频胆管镜（SOVC）在 PSC 患者内镜管理中的应用价值。
在这项观察性研究中，纳入了 2015 年至 2019 年间在德国一家三级转诊中心行数字 SOVC（使用 SpyGlass DS 系统）的所有 PSC 病史患者，并进行回顾性分析。共识别出 38 例 PSC 病史患者的 46 次 SOVC。主要终点是使用数字 SOVC 评估主要胆管狭窄，次要终点是选择性导丝通过胆管狭窄和 PSC 患者胆道结石病的诊断和治疗。
38 例患者中有 22 例（57.9%）存在主要胆管狭窄。在这 22 例患者中的 4 例中，在狭窄部位诊断出胆管细胞癌（18.2%）。使用光学征象对主要胆管狭窄进行诊断性评估显示，检测恶性狭窄的敏感性为 75%，特异性为 94.4%，而 SOVC 引导活检以获取组织进行组织病理学分析的敏感性为 50%，特异性为 100%。在 13%的检查中，SOVC 有助于通过传统方法无法通过的胆管狭窄导丝通过（技术成功率为 100%）。17.4%的检查中观察到胆道结石病；其中，37.5%的检查仅通过 SOVC而不是标准荧光透视观察到胆道结石。所有胆道结石病的治疗均成功（100%）；25%需要 SOVC 辅助的液电碎石术。13%的检查中发生了介入后胆管炎和胰腺炎等并发症；然而，没有与程序相关的死亡。
数字 SOVC 是一种有效且安全的方法，可用于 PSC 患者的内镜管理，并且可以作为这些患者复杂内镜管理的附加工具定期考虑。
