Different diagnostic procedures exist for the detection of bile duct lesions in clinical practice.However,neither retrograde contrast imaging of the bile duct endoscopic retrograde cholangiopancreatogram nor other ima...Different diagnostic procedures exist for the detection of bile duct lesions in clinical practice.However,neither retrograde contrast imaging of the bile duct endoscopic retrograde cholangiopancreatogram nor other imaging procedures allow a safe diagnosis of the lesions.Therefore choledochoscopy may be a useful diagnostic procedure in macroscopic assessing lesions of the bile duct.Even if the diagnostic sensitivity and specificity is not sufficient,first studies suggest an enhanced diagnostic accuracy for choledochoscopy.Since the progress of choledochoscopy has started in the 1970 different improvements were achieved.Meanwhile,the examination can be performed by an examiner and samples can be taken.Image and Resolution quality has improved over the past years,also.The SpyGlass system is a technically advanced cholangioscopic device to provide endoscopic diagnosis in case of inconclusive bile duct findings.Further more,two more lumina allow specific biopsy forceps and optical fibers for electrohydraulic or laser lithotripsy.The most frequent useful insert of SpyGlass in clinical practice are in complex gallstones and bile duct lesions of unclear dignity.展开更多
Choledochoscopy,or cholangioscopy,is an endoscopic procedure for direct visualization within the biliary tract for diagnostic or therapeutic purposes.Since its conception in 1879,many variations and improvements are m...Choledochoscopy,or cholangioscopy,is an endoscopic procedure for direct visualization within the biliary tract for diagnostic or therapeutic purposes.Since its conception in 1879,many variations and improvements are made to ensure relevance in diagnosing and managing a range of intrahepatic and extrahepatic biliary pathologies.This ranges from improved visual impression and optical guided biopsies of indeterminate biliary strictures and clinically indistinguishable pathologies to therapeutic uses in stone fragmentation and other ablative therapies.Furthermore,with the evolving understanding of biliary disorders,there are significant innovative ideas and techniques to fill this void,such as nuanced instances of biliary stenting and retrieving migrated ductal stents.With this in mind,we present a review of the current advancements in choledochoscopy with new supporting evidence that further delineates the role of choledochoscopy in various diagnostic and therapeutic interventions,complications,limitations and put forth areas for further study.展开更多
Background Mirizzi syndrome is often difficult to diagnose before surgery, and is often accompanied by extensive adhesions in the cystohepatic （Calot＇s） triangle and the difficulty of separating tissue can lead to ...Background Mirizzi syndrome is often difficult to diagnose before surgery, and is often accompanied by extensive adhesions in the cystohepatic （Calot＇s） triangle and the difficulty of separating tissue can lead to bile duct injury and other intraoperative and postoperative complications. The aim of this study is to investigate minimally invasive means of treating different types of Mirizzi syndrome. Methods Fifty-four patients diagnosed with Mirizzi syndrome were enrolled between July 2004 and May 2012. The diagnosis was further refined according to the Csendes classification. Twenty-seven patients were treated with a combination of endoscopic retrograde cholangiopancreatography （ERCP）, laparoscopy, and choledochoscopy （tripartite approach group）; type I in 16 cases, type II five cases, and type III in six cases. Twenty-seven patients were treated with laparotomy （routine approach group）; type I in 19 cases, type II in six cases, and type III in two cases. The operation time, blood loss during operation, initiation of intake time of food, postoperative complications, and hospital stays were compared between two groups. Results All patients were successfully cured in surgical operation. The operation time was （49.7±27.5） minutes, blood loss during operation was （21.1±15.9） ml, initiation of intake time of food was （6.3±2.7） hours, postoperative complications were with two cases （7%, 2/27）, and hospital stay was （6.7±1.8） days in the tripartite approach group. In the routine approach group, the operation time was （85.1±20.3） minutes, blood loss during operation was （150.3±20.5） ml, initiation of intake time of food was （36.6±10.3） hours, postoperative complications were with three cases （11%, 3/27）, and hospital stay was （10.9±3.4） days. Except for postoperative complications, there were significant differences in the operation time, blood loss during operation, initiation of intake time of food, and hospital stays between two groups （P 〈0.05）. Conclusions ERCP combined with laparoscopy and choledochoscopy is a safe and effective means of treating Mirizzi syndrome. The approach is minimally invasive and patients recover quickly requiring only brief hospitalization.展开更多
Objective: To probe the potential use of duodenosco- py in the diagnosis and treatment of acute gallstone pancreatitis (GP). Methods: Fourty-five patients with acute GP were randomly divided into endoscopic retrograde...Objective: To probe the potential use of duodenosco- py in the diagnosis and treatment of acute gallstone pancreatitis (GP). Methods: Fourty-five patients with acute GP were randomly divided into endoscopic retrograde cholan- giopancreatography (ERCP) group (n=20) and non-ERCP group (n=25). Each group was subdivi- ded into mild and severe groups according to A- PACHE Ⅱ scores. They were given supportive treat- ment combined with traditional Chinese medicine. The patients in the ERCP group received ERCP within 24 hours after admission. If there were stones in the common bile duct with stenosis of the inferior extremity or ampulla, endoscopic sphincterotomy (ES) was performed to extract the stones by basket. If no calculi were identified or multiple stones were large, endoscopic naso-biliary drainage (ENBD) was carried out. Results: The incidence of complication, length of hospitalization and cost were markedly lower in pa- tients with severe acute GP in the ERCP group than those in the non-ERCP group (P<0.05), in contrast to the 2 mild subgroups of the ERCP and non-ERCP groups (P>0.05). Conclusion: It is feasible, effective and safe to apply duodenoseopy in the treatment of severe acute GP.展开更多
Intraductal endoscopy describes the use of an endoscope to directly visualize the biliary and pancreatic ducts. For many years, technological challenges have made performing these procedures difficult. The "mothe...Intraductal endoscopy describes the use of an endoscope to directly visualize the biliary and pancreatic ducts. For many years, technological challenges have made performing these procedures difficult. The "mother-baby" system and other various miniscopes have been developed, but routine use has been hampered due to complex setup, scope fragility and the time consuming, technically demanding nature of the procedure. Recently, the SpyGlass peroral cholangiopancreatoscopy system has shown early success at providing diagnostic information and therapeutic options. The clinical utility of intraductal endoscopy is broad. It allows better differentiation between benign and malignant processes by allowing direct visualization and targeted sampling of tissue. Therapeutic interventions, such as electrohydraulic lithotripsy (EHL), laser lithotripsy, photodynamic therapy, and argon plasma coagulation (APC), may also be performed as part of intraductal endoscopy. Intraductal endoscopy significantly increases the diagnostic and therapeutic yield of standard endoscopic retrograde cholangiography (ERCP), and as technology progresses, it is likely that its utilization will only increase. In this review of intraductal endoscopy, we describe in detail the various endoscopic platforms and their diagnostic and clinical applications.展开更多
文摘Different diagnostic procedures exist for the detection of bile duct lesions in clinical practice.However,neither retrograde contrast imaging of the bile duct endoscopic retrograde cholangiopancreatogram nor other imaging procedures allow a safe diagnosis of the lesions.Therefore choledochoscopy may be a useful diagnostic procedure in macroscopic assessing lesions of the bile duct.Even if the diagnostic sensitivity and specificity is not sufficient,first studies suggest an enhanced diagnostic accuracy for choledochoscopy.Since the progress of choledochoscopy has started in the 1970 different improvements were achieved.Meanwhile,the examination can be performed by an examiner and samples can be taken.Image and Resolution quality has improved over the past years,also.The SpyGlass system is a technically advanced cholangioscopic device to provide endoscopic diagnosis in case of inconclusive bile duct findings.Further more,two more lumina allow specific biopsy forceps and optical fibers for electrohydraulic or laser lithotripsy.The most frequent useful insert of SpyGlass in clinical practice are in complex gallstones and bile duct lesions of unclear dignity.
文摘Choledochoscopy,or cholangioscopy,is an endoscopic procedure for direct visualization within the biliary tract for diagnostic or therapeutic purposes.Since its conception in 1879,many variations and improvements are made to ensure relevance in diagnosing and managing a range of intrahepatic and extrahepatic biliary pathologies.This ranges from improved visual impression and optical guided biopsies of indeterminate biliary strictures and clinically indistinguishable pathologies to therapeutic uses in stone fragmentation and other ablative therapies.Furthermore,with the evolving understanding of biliary disorders,there are significant innovative ideas and techniques to fill this void,such as nuanced instances of biliary stenting and retrieving migrated ductal stents.With this in mind,we present a review of the current advancements in choledochoscopy with new supporting evidence that further delineates the role of choledochoscopy in various diagnostic and therapeutic interventions,complications,limitations and put forth areas for further study.
文摘Background Mirizzi syndrome is often difficult to diagnose before surgery, and is often accompanied by extensive adhesions in the cystohepatic （Calot＇s） triangle and the difficulty of separating tissue can lead to bile duct injury and other intraoperative and postoperative complications. The aim of this study is to investigate minimally invasive means of treating different types of Mirizzi syndrome. Methods Fifty-four patients diagnosed with Mirizzi syndrome were enrolled between July 2004 and May 2012. The diagnosis was further refined according to the Csendes classification. Twenty-seven patients were treated with a combination of endoscopic retrograde cholangiopancreatography （ERCP）, laparoscopy, and choledochoscopy （tripartite approach group）; type I in 16 cases, type II five cases, and type III in six cases. Twenty-seven patients were treated with laparotomy （routine approach group）; type I in 19 cases, type II in six cases, and type III in two cases. The operation time, blood loss during operation, initiation of intake time of food, postoperative complications, and hospital stays were compared between two groups. Results All patients were successfully cured in surgical operation. The operation time was （49.7±27.5） minutes, blood loss during operation was （21.1±15.9） ml, initiation of intake time of food was （6.3±2.7） hours, postoperative complications were with two cases （7%, 2/27）, and hospital stay was （6.7±1.8） days in the tripartite approach group. In the routine approach group, the operation time was （85.1±20.3） minutes, blood loss during operation was （150.3±20.5） ml, initiation of intake time of food was （36.6±10.3） hours, postoperative complications were with three cases （11%, 3/27）, and hospital stay was （10.9±3.4） days. Except for postoperative complications, there were significant differences in the operation time, blood loss during operation, initiation of intake time of food, and hospital stays between two groups （P 〈0.05）. Conclusions ERCP combined with laparoscopy and choledochoscopy is a safe and effective means of treating Mirizzi syndrome. The approach is minimally invasive and patients recover quickly requiring only brief hospitalization.
文摘Objective: To probe the potential use of duodenosco- py in the diagnosis and treatment of acute gallstone pancreatitis (GP). Methods: Fourty-five patients with acute GP were randomly divided into endoscopic retrograde cholan- giopancreatography (ERCP) group (n=20) and non-ERCP group (n=25). Each group was subdivi- ded into mild and severe groups according to A- PACHE Ⅱ scores. They were given supportive treat- ment combined with traditional Chinese medicine. The patients in the ERCP group received ERCP within 24 hours after admission. If there were stones in the common bile duct with stenosis of the inferior extremity or ampulla, endoscopic sphincterotomy (ES) was performed to extract the stones by basket. If no calculi were identified or multiple stones were large, endoscopic naso-biliary drainage (ENBD) was carried out. Results: The incidence of complication, length of hospitalization and cost were markedly lower in pa- tients with severe acute GP in the ERCP group than those in the non-ERCP group (P<0.05), in contrast to the 2 mild subgroups of the ERCP and non-ERCP groups (P>0.05). Conclusion: It is feasible, effective and safe to apply duodenoseopy in the treatment of severe acute GP.
文摘Intraductal endoscopy describes the use of an endoscope to directly visualize the biliary and pancreatic ducts. For many years, technological challenges have made performing these procedures difficult. The "mother-baby" system and other various miniscopes have been developed, but routine use has been hampered due to complex setup, scope fragility and the time consuming, technically demanding nature of the procedure. Recently, the SpyGlass peroral cholangiopancreatoscopy system has shown early success at providing diagnostic information and therapeutic options. The clinical utility of intraductal endoscopy is broad. It allows better differentiation between benign and malignant processes by allowing direct visualization and targeted sampling of tissue. Therapeutic interventions, such as electrohydraulic lithotripsy (EHL), laser lithotripsy, photodynamic therapy, and argon plasma coagulation (APC), may also be performed as part of intraductal endoscopy. Intraductal endoscopy significantly increases the diagnostic and therapeutic yield of standard endoscopic retrograde cholangiography (ERCP), and as technology progresses, it is likely that its utilization will only increase. In this review of intraductal endoscopy, we describe in detail the various endoscopic platforms and their diagnostic and clinical applications.
