Skenteris George, Singletary Trey, Grasso Lindsay, Self Stella, Schammel David P, Schammel Christine M G, Jones Wes, Devane A Michael
University of South Carolina School of Medicine Greenville, Greenville, SC, USA.
Department of Epidemiology, Arnold School of Public Health, University of South Carolina, Greenville, SC, USA.
Surg Endosc. 2025 Feb;39(2):1140-1146. doi: 10.1007/s00464-024-11422-5. Epub 2024 Dec 19.
Evaluation of lesions of the biliary tract are essential to diagnose given the dismal outcomes of cholangiocarcinoma. Historically, these diagnoses were made using brush biopsies obtained under Endoscopic Retrograde Cholangiopancreatography (ERCP). To increase the accuracy of biliary biopsies, SpyGlassTM Discover cholangioscopy guided biopsy has been developed, providing greater tissue yield and direct visualization of the biliary epithelium. We evaluated the diagnostic accuracy of ERCP guided brushings and SpyGlassTM Discover guided biopsies at a single institution.
Following IRB approval, all diagnostic biliary biopsies utilizing both ERCP guided brushings and/or SpyGlassTM Discover between 8/2015 and 6/2022 were retrospectively evaluated. Demographic and clinicopathologic data were collected. Fischer's t-tests and Chi-square analyses were completed as appropriate (p < 0.05).
Overall, 46 patients with an average age of 61 years were included in this study; 59% of the patients were female and 41% were male. 87% of patients had at least one SpyGlassTM Discover guided biopsy and one ERCP guided brushing and 13% of patients had at least one SpyGlassTM Discover guided biopsy alone. SpyGlassTM Discover correctly identified 82% of malignancies while brushings identified only 47% of malignancies.
SpyGlassTM Discover guided biopsies yield a greater diagnostic result than ERCP guided brushings. Therefore, SpyGlassTM Discover should be considered as the standard for diagnosing biliary lesions at our institution in conjunction with ERCP procedure. The classification of visual characteristics of biliary lesions should be investigated in the future as the high-resolution image generated by SpyGlassTM Discover can allow for detailed visual observation of strictures and potentially aid in better characterization and location of disease.
鉴于胆管癌预后不佳，对胆道病变进行评估对于诊断至关重要。从历史上看，这些诊断是通过在逆行胰胆管造影术（ERCP）下获取的刷检活检来进行的。为了提高胆道活检的准确性，已开发出SpyGlassTM Discover胆管镜引导活检，可提供更高的组织获取量并直接观察胆管上皮。我们在单一机构评估了ERCP引导刷检和SpyGlassTM Discover引导活检的诊断准确性。
在获得机构审查委员会（IRB）批准后，对2015年8月至2022年6月期间所有使用ERCP引导刷检和/或SpyGlassTM Discover进行的诊断性胆道活检进行回顾性评估。收集人口统计学和临床病理数据。酌情完成费舍尔t检验和卡方分析（p < 0.05）。
总体而言，本研究纳入了46例平均年龄为61岁的患者；59%为女性，41%为男性。87%的患者至少进行了一次SpyGlassTM Discover引导活检和一次ERCP引导刷检，13%的患者仅进行了至少一次SpyGlassTM Discover引导活检。SpyGlassTM Discover正确识别了82%的恶性肿瘤，而刷检仅识别了47%的恶性肿瘤。
SpyGlassTM Discover引导活检比ERCP引导刷检产生更高的诊断结果。因此，在我们机构，SpyGlassTM Discover应与ERCP程序一起被视为诊断胆道病变的标准。由于SpyGlassTM Discover生成的高分辨率图像可以对狭窄进行详细的视觉观察，并可能有助于更好地对疾病进行特征描述和定位，未来应研究胆道病变视觉特征的分类。
