PDF(Pubmed)
Abstract：
UNASSIGNED: Percutaneous cholangioscopy (PerC) offers an alternative for patients with an inaccessible biliary tree. This systematic review and meta-analysis aimed to evaluate the performance of this technique.
UNASSIGNED: A search in Medline, Cochrane and ClinicalTrials.gov databases was performed for studies assessing PerC up to October 2022. The primary outcome was diagnostic success, defined as successful stone identification or stricture workup. Secondary outcomes included therapeutic success (stone extraction, stenting) and complication rate. A subgroup analysis compared previous-generation and modern cholangioscopes. We performed meta-analyses using a random-effects model and the results were reported as percentages with 95% confidence interval (CI).
UNASSIGNED: Fourteen studies (682 patients) were eligible for analysis. The rate of diagnostic success was 98.7% (95%CI 97.6-99.8%; I2=31.19%) and therapeutic success was 88.6% (95%CI 82.8-94.3%; I2=74.92%). Adverse events were recorded in 17.1% (95%CI 10.7-23.5%; I2=77.56%), of which 15.9% (95%CI 9.8-21.9%; I2=75.98%) were minor and 0.6% (95%CI 0.1-1.2%; I2=0%) major. The Spyglass system showed null heterogeneity for all outcomes; compared with older-generation endoscopes it offered comparable diagnostic success, but yielded significantly superior therapeutic success (96.1%, 95%CI 90-100%; I2=0% vs. 86.4%, 95%CI 79.2-93.6%; I2=81.41%; P=0.02].
UNASSIGNED: PerC, especially using currently available cholangioscopes, is associated with high diagnostic and therapeutic success.
UNASSIGNED: A search in Medline, Cochrane and ClinicalTrials.gov databases was performed for studies assessing PerC up to October 2022. The primary outcome was diagnostic success, defined as successful stone identification or stricture workup. Secondary outcomes included therapeutic success (stone extraction, stenting) and complication rate. A subgroup analysis compared previous-generation and modern cholangioscopes. We performed meta-analyses using a random-effects model and the results were reported as percentages with 95% confidence interval (CI).
UNASSIGNED: Fourteen studies (682 patients) were eligible for analysis. The rate of diagnostic success was 98.7% (95%CI 97.6-99.8%; I2=31.19%) and therapeutic success was 88.6% (95%CI 82.8-94.3%; I2=74.92%). Adverse events were recorded in 17.1% (95%CI 10.7-23.5%; I2=77.56%), of which 15.9% (95%CI 9.8-21.9%; I2=75.98%) were minor and 0.6% (95%CI 0.1-1.2%; I2=0%) major. The Spyglass system showed null heterogeneity for all outcomes; compared with older-generation endoscopes it offered comparable diagnostic success, but yielded significantly superior therapeutic success (96.1%, 95%CI 90-100%; I2=0% vs. 86.4%, 95%CI 79.2-93.6%; I2=81.41%; P=0.02].
UNASSIGNED: PerC, especially using currently available cholangioscopes, is associated with high diagnostic and therapeutic success.
摘要：
■经皮胆道镜检查（PerC）为胆道树难以接近的患者提供了一种替代方法。本系统综述和荟萃分析旨在评估该技术的性能。
■在Medline中搜索，Cochrane和ClinicalTrials.gov数据库用于评估截至2022年10月的PerC的研究。主要结果是诊断成功，定义为成功的石头识别或狭窄检查。次要结果包括治疗成功(结石拔除，支架置入)和并发症发生率。亚组分析比较了上一代和现代胆道镜。我们使用随机效应模型进行荟萃分析，结果以95%置信区间（CI）的百分比报告。
■14项研究（682名患者）符合分析条件。诊断成功率为98.7%（95CI97.6-99.8%；I2=31.19%），治疗成功率为88.6%（95CI82.8-94.3%；I2=74.92%）。不良事件记录为17.1％（95CI10.7-23.5％；I2=77.56％），其中15.9%（95CI9.8-21.9%；I2=75.98%）为次要，0.6%（95CI0.1-1.2%；I2=0%）为主要。Spyglass系统显示所有结果均为零异质性；与老一代内窥镜相比，它提供了相当的诊断成功率。但取得了显著优异的治疗成功率(96.1%，95CI90-100%；I2=0%vs.86.4%,95CI79.2-93.6%；I2=81.41%；P=0.02]。
■PerC,尤其是使用目前可用的胆道镜，与高诊断和治疗成功率相关。
■在Medline中搜索，Cochrane和ClinicalTrials.gov数据库用于评估截至2022年10月的PerC的研究。主要结果是诊断成功，定义为成功的石头识别或狭窄检查。次要结果包括治疗成功(结石拔除，支架置入)和并发症发生率。亚组分析比较了上一代和现代胆道镜。我们使用随机效应模型进行荟萃分析，结果以95%置信区间（CI）的百分比报告。
■14项研究（682名患者）符合分析条件。诊断成功率为98.7%（95CI97.6-99.8%；I2=31.19%），治疗成功率为88.6%（95CI82.8-94.3%；I2=74.92%）。不良事件记录为17.1％（95CI10.7-23.5％；I2=77.56％），其中15.9%（95CI9.8-21.9%；I2=75.98%）为次要，0.6%（95CI0.1-1.2%；I2=0%）为主要。Spyglass系统显示所有结果均为零异质性；与老一代内窥镜相比，它提供了相当的诊断成功率。但取得了显著优异的治疗成功率(96.1%，95CI90-100%；I2=0%vs.86.4%,95CI79.2-93.6%；I2=81.41%；P=0.02]。
■PerC,尤其是使用目前可用的胆道镜，与高诊断和治疗成功率相关。
