PDF(Pubmed)
Abstract：
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%, p < 0.05). Both DSOC visualization and IDUS exhibited optimal diagnostic yields in differentiating IBS with an acceptable safety profile.
摘要：
由于标准诊断方法的敏感性低，胆道狭窄的评估提出了挑战。但直接单操作胆道镜检查(DSOC)的出现彻底改变了这一模式.我们的研究旨在评估DSOC和DSOC靶向活检的诊断性能，导管内超声（IDUS），和不确定胆道狭窄（IBS）患者的标准刷状细胞学检查。我们回顾了2018年1月至2022年12月在我们的内窥镜单元接受IBS高级诊断评估的患者，所有这些患者之前都经历过至少一次内窥镜尝试来表征胆道狭窄。最终诊断是基于手术病理和/或临床和放射学随访至少12个月建立的。共有57名患者，平均年龄为67.2±10.0岁，包括在内，平均随访18.2±18.1个月。大部分IBS位于胆总管远端(45.6%),35例（61.4％）确诊为恶性肿瘤。DSOC和IDUS显示出明显更高的准确性（89.5%和82.7%，分别)与标准细胞学(61.5%，p<0.05)。DSOC可视化和IDUS在区分具有可接受的安全性的IBS方面均表现出最佳的诊断率。
