Consensus guidelines on the role of cholangioscopy to diagnose indeterminate biliary stricture

被引：35

作者：

Angsuwatcharakon, Phonthep ^{[1
,2
,3
]}

Kulpatcharapong, Santi ^{[1
]}

Moon, Jong H. ^{[4
]}

Ramchandani, Mohan ^{[5
]}

Lau, James ^{[6
]}

Isayama, Hiroyuki ^{[7
]}

Seo, Dong W. ^{[8
]}

Maydeo, Amit ^{[9
]}

Wang, Hsiu-P ^{[10
]}

Nakai, Yousuke ^{[11
]}

Ratanachu-ek, Thawee ^{[12
]}

Bapaye, Amol ^{[13
]}

Hu, Bing ^{[14
]}

Devereaux, Benedict ^{[15
]}

Ponnudurai, Ryan ^{[16
]}

Khor, Christopher ^{[17
,18
]}

Kongkam, Pradermchai ^{[1
]}

Pausawasdi, Nonthalee ^{[19
]}

Ridtitid, Wiriyaporn ^{[1
]}

Piyachaturawat, Panida ^{[1
]}

Khanh, Pham C. ^{[20
]}

Dy, Federick ^{[21
]}

Rerknimitr, Rungsun ^{[1
,22
]}

机构：

[1] Chulalongkorn Univ, Fac Med, Dept Med, Div Gastroenterol, Bangkok, Thailand

[2] Chulalongkorn Univ, Fac Med, Dept Anat, Bangkok, Thailand

[3] King Chulalongkorn Mem Hosp, Bangkok, Thailand

[4] SoonChunHyang Univ, Digest Dis Ctr & Res Inst, Dept Internal Med, Sch Med, Seoul, South Korea

[5] Asian Inst Gastroenterol, Hyderabad, India

[6] Chinese Univ Hong Kong, Prince Wales Hosp, Endoscop Ctr, Dept Surg, Hong Kong, Peoples R China

[7] Juntendo Univ, Grad Sch Med, Dept Gastroenterol, Tokyo, Japan

[8] Univ Ulsan, Asan Med Ctr, Dept Internal Med, Coll Med, Seoul, South Korea

[9] Global Gleneagles Hosp, Baldota Inst Digest Sci, Mumbai, Maharashtra, India

[10] Natl Taiwan Univ, Coll Med, Dept Internal Med, Taipei, Taiwan

[11] Univ Tokyo, Dept Endoscopy, Tokyo, Japan

[12] Rajavithi Hosp, Dept Surg, Bangkok, Thailand

[13] Deenanath Mangeshkar Hosp & Res Ctr, Shivanand Desai Ctr Digest Disorders, Pune, Maharashtra, India

[14] Naval Med Univ, Eastern Hepatobiliary Hosp, Dept Gastroenterol, Shanghai, Peoples R China

[15] Univ Queensland, Royal Brisbane & Womens Hosp, Brisbane, Qld, Australia

[16] Prince Court Med Ctr, Kuala Lumpur, Malaysia

[17] Singapore Gen Hosp, Dept Gastroenterol & Hepatol, Singapore, Singapore

[18] Duke NUS Med Sch, Singapore, Singapore

[19] Mahidol Univ, Fac Med, Dept Internal Med, Div Gastroenterol,Siriraj Hosp, Bangkok, Thailand

[20] Univ Med Ctr, Dept Endoscopy, Ho Chi Minh City, Vietnam

[21] Univ Santo Tomas Hosp, Fac Med & Surg, Dept Internal Med, Sect Gastroenterol, Manila, Philippines

[22] Chulalongkorn Univ, Fac Med, Ctr Excellence Innovat & Endoscopy Gastrointestin, Bangkok, Thailand

来源：

HPB | 2022年 / 24卷 / 01期

关键词：

SINGLE-OPERATOR CHOLANGIOSCOPY; DIRECT PERORAL CHOLANGIOSCOPY; BILE-DUCT LESIONS; TISSUE ACQUISITION; PERFORMANCE; CHOLANGIOPANCREATOSCOPY; ACCURACY; CYTOLOGY; DISEASES; IMPACT;

D O I：

10.1016/j.hpb.2021.05.005

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Background: Indeterminate strictures pose a therapeutic dilemma. In recent years, cholangioscopy has evolved and the availability of cholangioscopy has increased. However, the position of cholangioscopy in the diagnostic algorithm to diagnose malignancy have not been well established. We aim to develop a consensus statement regarding the clinical role of cholangioscopy in the diagnosis of indeterminate biliary strictures. Methods: The international experts reviewed the evidence and modified the statements using a three-step modified Delphi method. Each statement achieves consensus when it has at least 80% agreement. Results: Nine final statements were formulated. An indeterminate biliary stricture is defined as that of uncertain etiology under imaging or tissue diagnosis. When available, cholangioscopic assessment and guided biopsy during the first round of ERCP may reduce the need to perform multiple procedures. Cholangioscopy are helpful in diagnosing malignant biliary strictures by both direct visualization and targeted biopsy. The absence of disease progression for at least 6 months is supportive of non-malignant etiology. Direct per-oral cholangioscopy provides the largest accessory channel, better image definition, with image enhancement but is technically demanding. Image enhancement during cholangioscopy may increase the diagnostic sensitivity of visual impression of malignant biliary stric-tures. Cholangioscopic imaging characteristics including tumor vessels, papillary projection, nodular or polypoid mass, and infiltrative lesions are highly suggestive for neoplastic/malignant biliary disease. The risk of cholangioscopy related cholangitis is higher than in standard ERCP, necessitating prophylactic antibiotics and ensuring adequate biliary drainage. Per-oral cholangioscopy may not be the modality of choice in the evaluation of distal biliary strictures due to inherent technical difficulties. Conclusion: Evidence supports that cholangioscopy has an adjunct role to abdominal imaging and ERCP tissue acquisition in order to evaluate and diagnose indeterminate biliary strictures.

引用

页码：17 / 29

页数：13