Tag-Adeen Mohammed, Malak Mohamed, Abdel-Gawad Muhammad, Abu-Elfatth Ahmed, Eldamarawy Ramadan H, Alzamzamy Ahmed, Elbasiony Mohamed, Elsharkawy Ramy M, El-Raey Fathiya, Basiony Ahmed N, Qasem Ahmed, Shady Zakarya, Abdelmohsen Ahmed S, Abdeltawab Doaa, Farouk Mahmoud, Fouad Ola M, Rabie Ahmed, Erian Abdul-Hakim, Sapra Ahlam, Shaibat-Alhamd Wael, Aboubakr Ashraf, Omran Dalia, Alboraie Mohamed
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Qena Faculty of Medicine, South Valley University, Qena, Egypt.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, Sohag University, Sohag, Egypt.
Front Med (Lausanne). 2023 Jan 9;9:1018201. doi: 10.3389/fmed.2022.1018201. eCollection 2022.
Indeterminate biliary stricture (IBS) is a frequently encountered clinical problem. In this study, we aimed to highlight the clinical characteristics, risk factors and diagnostic outcomes of patients presented with indeterminate biliary stricture.
A Retrospective multicenter study included all patients diagnosed with IBS in the participating centers between 2017 and 2021. Data regarding IBS such as presentations, patient characteristics, diagnostic and therapeutic modalities were collected from the patients' records and then were analyzed.
Data of 315 patients with IBS were retrospectively collected from 7 medical centers with mean age: 62.6 ± 11 years, females: 40.3% and smokers: 44.8%. For diagnosing stricture; Magnetic resonance imaging/Magnetic resonance cholangiopancreatography (MRI/MRCP) was the most frequently requested imaging modality in all patients, Contrast enhanced computerized tomography (CECT) in 85% and endoscopic ultrasound (EUS) in 23.8%. Tissue diagnosis of cholangiocarcinoma was achieved in 14% only. The used therapeutic modalities were endoscopic retrograde cholangiopancreatography (ERCP)/stenting in 70.5%, percutaneous trans-hepatic biliary drainage (PTD): 17.8%, EUS guided drainage: 0.3%, and surgical resection in 8%. The most frequent type of strictures was distal stricture in 181 patients, perihilar in 128 and intrahepatic in 6. Distal strictures had significant male predominance, with higher role for EUS for diagnosis and higher role for ERCP/stenting for drainage, while in the perihilar strictures, there was higher role for CECT and MRI/MRCP for diagnosis and more frequent use of PTD for drainage.
Indeterminate biliary stricture is a challenging clinical problem with lack of tissue diagnosis in most of cases mandates an urgent consensus diagnostic and treatment guidelines.
不明原因胆管狭窄（IBS）是临床常见问题。本研究旨在突出不明原因胆管狭窄患者的临床特征、危险因素及诊断结果。
一项回顾性多中心研究纳入了2017年至2021年参与中心所有诊断为IBS的患者。从患者记录中收集有关IBS的资料，如临床表现、患者特征、诊断和治疗方式，然后进行分析。
从7个医疗中心回顾性收集了315例IBS患者的数据，平均年龄为62.6±11岁，女性占40.3%，吸烟者占44.8%。对于狭窄的诊断，磁共振成像/磁共振胰胆管造影（MRI/MRCP）是所有患者中最常要求的成像方式，85%的患者进行了对比增强计算机断层扫描（CECT），23.8%的患者进行了内镜超声（EUS）检查。仅14%的患者获得了胆管癌的组织学诊断。所采用的治疗方式包括内镜逆行胰胆管造影（ERCP）/支架置入术占70.5%，经皮经肝胆管引流（PTD）占17.8%，EUS引导下引流占0.3%，手术切除占8%。最常见的狭窄类型为远端狭窄181例，肝门周围狭窄128例，肝内狭窄6例。远端狭窄男性占显著优势，EUS在诊断中作用更大，ERCP/支架置入术在引流中作用更大；而在肝门周围狭窄中，CECT和MRI/MRCP在诊断中作用更大，PTD引流更常用。
不明原因胆管狭窄是一个具有挑战性的临床问题，大多数病例缺乏组织学诊断，迫切需要达成共识的诊断和治疗指南。
