Sacco Marco, Gesualdo Marcantonio, Staiano Maria Teresa, Dall'Amico Eleonora, Caronna Stefania, Dibitetto Simone, Canalis Chiara, Caneglias Alessandro, Mediati Federica, Stasio Rosa Claudia, Gaia Silvia, Saracco Giorgio Maria, Bruno Mauro, De Angelis Claudio Giovanni
Endoscopy Unit, Gastroenterology Department, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy.
Endoscopy Unit, Gastroenterology Department, Section of Gastroenterology II, National Institute of Research IRCCS "Saverio De Bellis", 70013 Castellana Grotte, Italy.
Diagnostics (Basel). 2024 Jun 21;14(13):1316. doi: 10.3390/diagnostics14131316.
The evaluation of biliary strictures poses a challenge due to the low sensitivity of standard diagnostic approaches, but the advent of direct single-operator cholangioscopy (DSOC) has revolutionized this paradigm. Our study aimed to assess the diagnostic performance of DSOC and DSOC-targeted biopsies, intraductal ultrasound (IDUS), and standard brush cytology in patients with indeterminate biliary strictures (IBS). We reviewed patients who underwent advanced diagnostic evaluation for IBS at our endoscopy unit from January 2018 to December 2022, all of whom had previously undergone at least one endoscopic attempt to characterize the biliary stricture. Final diagnoses were established based on surgical pathology and/or clinical and radiological follow-up spanning at least 12 months. A total of 57 patients, with a mean age of 67.2 ± 10.0 years, were included, with a mean follow-up of 18.2 ± 18.1 months. The majority of IBS were located in the distal common bile duct (45.6%), with malignancy confirmed in 35 patients (61.4%). DSOC and IDUS demonstrated significantly higher accuracies (89.5% and 82.7%, respectively) compared to standard cytology (61.5%, < 0.05). Both DSOC visualization and IDUS exhibited optimal diagnostic yields in differentiating IBS with an acceptable safety profile.
由于标准诊断方法的敏感性较低，胆管狭窄的评估面临挑战，但直接单人操作胆管镜检查（DSOC）的出现彻底改变了这一模式。我们的研究旨在评估DSOC、DSOC靶向活检、导管内超声（IDUS）和标准刷检细胞学在不确定胆管狭窄（IBS）患者中的诊断性能。我们回顾了2018年1月至2022年12月在我们内镜科接受IBS高级诊断评估的患者，所有患者此前至少接受过一次内镜检查以明确胆管狭窄的特征。最终诊断基于手术病理和/或至少12个月的临床及影像学随访确定。共纳入57例患者，平均年龄67.2±10.0岁，平均随访18.2±18.1个月。大多数IBS位于胆总管远端（45.6%），35例（61.4%）确诊为恶性肿瘤。与标准细胞学（61.5%）相比，DSOC和IDUS的准确率显著更高（分别为89.5%和82.7%，P<0.05）。DSOC可视化和IDUS在鉴别IBS方面均表现出最佳诊断率，且安全性良好。
