Mohamed Islam, Naeem Ahmed, Hassan Noor, Jung Daniel, Bader Abbas, Gaur Rishabh, Yousaf Abdulrehman, Abosheaishaa Hazem, Salem Ahmed E, Mohamed Wael T, Telbany Ahmed, Dahiya Dushyant Singh, Yusuke Hashimoto
Department of Internal Medicine, University of Missouri Kansas City, Kansas City, Missouri, USA.
Department of Medicine, School of Medicine, Al-Azhar University, Asyut, Egypt.
Eur J Gastroenterol Hepatol. 2025 May 1;37(5):523-533. doi: 10.1097/MEG.0000000000002909. Epub 2024 Dec 17.
Percutaneous transhepatic cholangioscopy (PTCS) is essential for managing patients with altered biliary anatomy when endoscopic retrograde cholangiopancreatography fails. This study aimed to compare the safety and efficacy of conventional PTCS (C-PTCS) with the SpyGlass PTCS (S-PTCS) system in cases of challenging biliary access. A systematic review and meta-analysis included 12 studies with 998 patients. Results indicated that S-PTCS had a significantly higher clinical success rate of 99% [confidence interval (CI): 96-100%] compared to 84% (CI: 73-95%) for C-PTCS ( P < 0.01). Both techniques showed high technical success rates of 99% (CI: 96-100%) for S-PTCS and 98% (CI: 97-100%) for C-PTCS, with no significant difference ( P = 0.61). Safety outcomes, such as pain, liver ischemia, hemobilia, cholangitis, and bleeding, were low and similar across both techniques. These findings highlight the superior clinical success of S-PTCS in challenging biliary access cases while maintaining comparable safety profiles with C-PTCS.
当内镜逆行胰胆管造影术失败时，经皮经肝胆道镜检查（PTCS）对于处理胆道解剖结构改变的患者至关重要。本研究旨在比较传统PTCS（C-PTCS）与SpyGlass PTCS（S-PTCS）系统在具有挑战性的胆道通路病例中的安全性和有效性。一项系统评价和荟萃分析纳入了12项研究，共998例患者。结果表明，S-PTCS的临床成功率显著更高，为99%[置信区间（CI）：96-100%]，而C-PTCS为84%（CI：73-95%）（P<0.01）。两种技术的技术成功率都很高，S-PTCS为99%（CI：96-100%），C-PTCS为98%（CI：97-100%），无显著差异（P=0.61）。疼痛、肝缺血、胆道出血、胆管炎和出血等安全性结果发生率较低，且两种技术相似。这些发现突出了S-PTCS在具有挑战性的胆道通路病例中的卓越临床成功率，同时与C-PTCS保持相当的安全性。
