A new peroral mother-baby endoscope system for biliary tract disorders

作     者：Christian Prinz Andreas Weber Stefanie Goecke Bruno Neu Alexander Meining Eckart Frimberger 

作者机构：Medical DepartmentUniversity of WittenLehrstuhl für Innere Medizin 2Helios Klinikum Wuppertal42283 WuppertalGermany Medical DepartmentTechnische Universitt München81675 MünchenGermany 

出 版 物：《World Journal of Gastrointestinal Endoscopy》 (世界胃肠内镜杂志（英文版）（电子版）)

年 卷 期：2014年第6卷第1期

页      面：20-26页

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

主　　题：Bile duct stenosis Stones,Mother baby endoscopy Peroral cholangioscopy Cholangioscopy Endoscopic retrograde cholangiopancreatography 

摘      要：AIM: To investigate a new mother-baby system, consisting of a peroral cholangioscope and a duodenoscope in patients regarding its feasibility. METHODS: In the study period from January 2007 to February 2010, 76 consecutive patients(33 men, 43 women; mean age 63 years old) were included in this pilot series. Endoluminal images and biopsies were obtained from 55 patients with indeterminate strictures, while 21 patients had fixed filling defects. The diagnostic accuracy of peroral cholangioscopy(POCS) in the visualization of strictures and tissue sampling was evaluated, and therapeutic success was monitored. Followup was performed over at least 9 mo. RESULTS: A total of 55 patients had indeterminate strictures. Using the criteria circular stenosis and irregular surface or margins, POCS correctly described 27 out of 28 malignant biliary strictures and 25 out of 27 benign lesions(sensitivity, 96.4%; specificity, 92.6%, diagnostic accuracy 94.5%). Visually targeted forceps biopsies were performed in 55 patients. Tissue sampling during POCS revealed malignancy in 18 of 28 cases(sensitivity: 64.3%). In 21 patients with fixed filling defects, 10 patients with bile duct stones were successfully treated with conventional stone removal. Nine patients with difficult stones(5 giant stones and 4 intrahepatic stones) were treated with visually guided laser lithotripsy. Two patients in the group with unclear fixed filling defects had bile duct adenoma or papillary tumors and were surgically treated. CONCLUSION: The new 95 cm POCS allows for accurate discrimination of strictures and fixed filling defects in the biliary tree, provides improved sensitivity of endoscopically guided biopsies and permits therapeutic approaches for difficult intrahepatic stones.