■为了比较细胞刷的诊断价值,ERCP引导活检,SpyGlass直接视觉印象和SpyGlass引导的生物间谍(SpyBite)在良性和恶性胆管狭窄的鉴别诊断中。
■1,008例临床诊断为不确定胆道狭窄并接受ERCP引导活检的患者的数据,细胞刷,收集2010年1月至2019年12月在南昌大学第一附属医院的SpyGlass直接视觉印象或SpyBite进行回顾性分析。最终诊断通过手术病理标本或随访确定(如果狭窄在一年的随访中显示恶性进展,则可以确定恶性狭窄)。通过敏感性评价上述内镜诊断方法的鉴别诊断价值,特异性,准确度,正预测值,负预测值,等。并通过不良事件发生率评价安全性.
■就灵敏度而言,标准活检组(48.6%)和SpyBite组(61.5%)明显高于细胞刷组(32.0%),视觉印象组(100%)明显高于其他任何组。就特异性而言,细胞刷组(99.0%),标准活检组(99.3%)和SpyBite组(100%)明显高于视觉印象(55.6%),但上述三组间无统计学差异。就准确性而言,标准活检组(65.3%),SpyBite组(80.0%)明显高于细胞刷组(44.4%),而SpyBite组(80.0%)明显高于视觉印象组(54.8%)。在安全方面,在ERCP术后胆管炎中,视觉印象组和SpyBite组明显高于细胞刷组和标准活检组。
■SpyBite结合SpyGlass引导的视觉印象在鉴别良恶性胆管狭窄的敏感性和准确性方面优于常规内镜诊断方法如细胞刷和标准活检。Furthmore,SpyGlass检查后的不良事件发生率与常规内镜诊断方法相似,但高度胆管炎除外,可以通过抗生素控制,并可以通过适当的胆道引流来避免。
UNASSIGNED: To compare the diagnostic value of cytobrush, ERCP-guided biopsy,
SpyGlass direct visual impression and
SpyGlass-guided biospy (SpyBite) in the differential diagnosis of benign and malignant bile duct strictures.
UNASSIGNED: The data of 1,008 patients who were clinically diagnosed with indeterminate biliary strictures and underwent ERCP-guided biopsy, cytobrush,
SpyGlass direct visual impression or SpyBite at the First Affiliated Hospital of Nanchang University between January 2010 and December 2019 were collected and analyzed retrospectively. The final diagnose was determined by surgical pathological specimen or follow-up (Malignant stricture can be identified if the stricture showed malignant progression during one year of follow-up). The differential diagnostic value of the above endoscopic diagnostic methods was evaluated by means of sensitivity, specificity, accuracy, positive predictive value, negative predictive value, etc. and safety was evaluated by the incidence rate of adverse events.
UNASSIGNED: In terms of sensitivity, standard biopsy group (48.6%) and SpyBite group (61.5%) were significantly higher than cytobrush group (32.0%), and visual impression group (100%) was significantly higher than any other group. As far as specificity was concerned, cytobrush group (99.0%), standard biopsy group (99.3%) and the SpyBite group (100%) were significantly higher than visual impression (55.6%), but there was no statistical difference among the three groups above. As far as accuracy was concerned, standard biopsy group (65.3%), and SpyBite group (80.0%) were significantly higher than cytobrush group (44.4%), and SpyBite group (80.0%) was significantly higher than visual impression group (54.8%). In terms of safety, visual impression group and SpyBite group were significantly higher than cytobrush group and standard biopsy group in post-ERCP cholangitis.
UNASSIGNED: SpyBite combined with
SpyGlass-guided visual impression was better for differential diagnosis of benign and malignant bile duct strictures in terms of sensitivity and accuracy compared with conventional endoscopic diagnostic methods such as cytobrush and standard biopsy. Furthmore, the incidence rates of adverse events after
SpyGlass examination was similar to those after conventional endoscopic diagnostic methods except for higher cholangitis, which could be controlled by antibiotics and might be avoided by adequate biliary drainage.