Department of Gastroenterology and Hepatology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China.
Endoscopy. 2023 Nov;55(11):1037-1042. doi: 10.1055/a-2113-8952. Epub 2023 Jun 20.
Selective biliary cannulation is the most challenging step in endoscopic retrograde cholangiopancreatography (ERCP) because only indirect radiographic images can be obtained. Therefore, we developed a novel endoscopic retrograde direct cholangioscopy (ERDC) technology to facilitate visible biliary cannulation. METHODS : In this case series, we used ERDC to treat 21 patients with common bile duct stones who were enrolled consecutively between July 2022 and December 2022. The procedure details and complications were recorded, and all patients were followed up for 3 months after the procedure. The learning curve effect was analyzed by comparing the early and later cases. RESULTS : Biliary cannulation was successful in all patients, and the stones were removed completely. The median (interquartile range [IQR]) time for cholangioscopy-guided biliary cannulation was 240.0 (10.0-430.0) seconds, and the median (IQR) number of cannulation procedures was 2 (1-5). Despite there being one episode of post-ERCP pancreatitis, one of cholangitis, and three patients developing asymptomatic hyperamylasemia, all of the patients recovered after symptomatic treatment, being discharged and with no serious adverse events occurring during the 3-month follow-up period. Compared with the early cases, the number of intubations and the use of guidewire guidance decreased in later cases. CONCLUSION : Our research confirms that ERDC is a feasible technology for biliary cannulation under direct vision.
选择性胆管插管是内镜逆行胰胆管造影（ERCP）中最具挑战性的步骤，因为只能获得间接的放射图像。因此，我们开发了一种新型的内镜逆行直接胆管镜检查（ERDC）技术，以方便可视胆管插管。方法：在这项病例系列研究中，我们使用 ERDC 治疗了 21 例胆总管结石患者，这些患者是在 2022 年 7 月至 2022 年 12 月期间连续入组的。记录了手术过程细节和并发症，并在手术后对所有患者进行了 3 个月的随访。通过比较早期和晚期病例，分析学习曲线效应。结果：所有患者均成功进行胆管插管，结石完全取出。胆管镜引导下胆管插管的中位（四分位距[IQR]）时间为 240.0（10.0-430.0）秒，中位（IQR）插管次数为 2（1-5）次。尽管有 1 例发生 ERCP 后胰腺炎、1 例发生胆管炎和 3 例患者出现无症状性高淀粉酶血症，但所有患者均在对症治疗后康复，出院，且在 3 个月的随访期间无严重不良事件发生。与早期病例相比，晚期病例的插管次数和导丝引导使用次数减少。结论：我们的研究证实，ERDC 是一种在直视下进行胆管插管的可行技术。
