Актуальность. Диагностика онкологических заболеваний, приводящих к формированию стриктур желчевыводящих протоков, является сложной задачей. При поступлении пациента в стационар с подозрением на стриктуру желчевыводящих путей изначально, как лечебно-диагностический метод, используется эндоскопическая ретроградная холангиопанкреатография (ЭРХПГ). Морфологическая диагностика стриктуры желчных протоков на основе ЭРХПГ с использованием браш-биопсии или внутрипротоковой щипцовой биопсии ограничена их низкой чувствительностью. Следовательно, значительная доля стриктур остается неопределенной, что и привело к развитию методов на основе холангиоскопии. Цель. Определить роль пероральной транспапиллярной холангиоскопии (ТХС) в специализированной онкологической клинике.
Материалы и методы. В ФГБУ «НМИЦ онкологии им. Н.Н. Блохина» Минздрава России на клинической апробации находилась система прямой визуализации SpyGlass для пероральных внутрипротоковых исследований компании Boston Scientific.
С помощью данной электронной системы выполнена ТХС у 4 пациентов с различными онкологическими заболеваниями. Результаты. Во всех случаях ТХС выполнена успешно. У всех пациентов диагноз подтвержден с помощью щипцовой внутрипротоковой биопсии с использованием щипцов Spybite. Заключение. Одноразовая электронная система прямой визуализации для проведения пероральных внутрипротоковых исследований и вмешательств типа SpyGlass может быть рекомендована для применения в специализированных онкологических центрах.
Relevance. Diagnosis of malignant diseases causing bile duct strictures is a big challenge. At admission, patients with suspected biliary tract stricture, initially undergo endoscopic retrograde cholangiopancreatography (ERCP) as a diagnostic and treatment method. The morphological diagnosis of bile duct stricture based on ERCP with brush biopsy or intraductal forceps biopsy is limited by their low sensitivity. Consequently, a significant proportion of strictures remains undiagnosed, which led to the development of methods based on cholangioscopy. Aim. To determine the role of per-oral transpapillary cholangioscopy (TCS) in a specialized cancer clinic. Materials and methods. SpyGlass direct visualization system for per-oral intraductal examination from Boston Scientific was clinically tasted in Blokhin National Medical Research Center of Oncology of the Ministry of Health of Russia. Using this electronic system, TCS was performed in 4 patients with various malignant diseases.
Results. In all cases, TCS was successful. In all patients, the diagnosis was confirmed with a forceps intraductal biopsy using Spybite forceps. Conclusion. Single-use electronic direct visualization system for per-oral intraductal examination and interventions like SpyGlass can be recommended for use in specialized cancer centers. Key words: endoscopic retrograde cholangiopancreatography, cholangioscopy, SpyGlass, intraductal biopsy, malignant strictures of the bile duct.
1. Roca J, Flichtentrei R, Parodi M. Progress in the radiologic study of the biliary tract in surgery; cholangioscopy and cholangiography; utilization of apparatus; preliminary note. Dia Med 1951; 23: 3420.
2. Berci G. General surgery: endoscopic exploration (choledoscopy) of the biliary system at operation. West J Med 1977; 126: 388.
3. Rösch W, Koch H, Demling L. Peroral cholangioscopy. Endoscopy 1976; 8: 172–5.
4. Urakami Y, Seifert E, Butke H. Peroral Direct Cholangioscopy (PDCS) Using Routine Straight-view Endoscope: First Report. Endoscopy 1977;
9: 27–30.
5. Chen YK. Preclinical characterization of the SpyGlass peroral cholangiopancreatoscopy system for direct access, visualization, and biopsy. Gastrointest Endosc 2007; 65: 303–11.
6. Lee JH, Kim HW, Kang DH et al. Usefulness of percutaneous transhepatic cholangioscopic lithotomy for removal of difficult common bile duct stones. Clin Endosc 2013; 46: 65–70.
7. Ahmed O, Mathevosian S, Arslan B. Biliary interventions: tools and techniques of the trade, access, cholangiography, biopsy, cholangioscopy, cholangioplasty, stenting, stone extraction, and brachytherapy. Semin Intervent Radiol 2016; 33: 283–90.
8. Ishida Y, Itoi T, Okabe Y. Types of Peroral Cholangioscopy: how to choose the most suitable type of cholangioscopy. Curr Treat Options Gastroenterol 2016; 14: 210–9.
9. Franzini TA, Moura RN, de Moura EG. Advances in therapeutic cholangioscopy. Gastroenterol Res Pract 2016; 2016: 5249152.
10. Chen YK, Pleskow DK. SpyGlass single-operator peroral cholangiopancreatoscopy system for the diagnosis and therapy of bile duct disorders: a clinical feasibility study (with video). Gastrointest Endosc 2007; 65: 832–41.
11. Draganov PV, Lin T, Chauhan S et al. Prospective evaluation of the clinical utility of ERCP-guided cholangiopancreatoscopy with a new direct visualization system. Gastrointest. Endosc 2011; 73: 971–9.
12. Judah JR, Draganov PV. The use of SpyGlass Direct Visualization System in the management of pancreatobiliary disease. Diagnostic and therapeutic procedures in gastroenterology. Humana Press 2011: 195–209.
13. Pereira P, Peixoto A, Andrade P et al. Peroral cholangiopancreatoscopy with the SpyGlassR system: What do we know 10 years later. J Gastrointestin Liver Dis 2017; 26: 165–70.
14. Moon JH, Ko BM Choi HJ et al. Direct peroral cholangioscopy using an ultra-slim upper endoscope for the treatment of retained bile duct stones. Am J Gastroenterol 2009; 104: 2729–33.
15. Komanduri S, Thosani N, Abu Dayyeh BK et al. Cholangiopancreatoscopy. Gastrointest Endosc 2016; 84: 209–21.
16. Brauer BC, Chen YK, Shah RJ. Single-step direct cholangioscopy by freehand intubation using standard endoscopes for diagnosis and therapy of biliary diseases. Am J Gastroenterol 2012; 107: 1030–5.
17. Komanduri S, Thosani N, Abu Dayyeh BK et al. ASGE Technology Committee. Cholangiopancreatoscopy. Gastrointest Endosc 2016; 84: 209–21.
18. Seo DW, Lee SK, Yoo KS et al. Cholangioscopic findings in bile duct tumors. Gastrointest Endosc 2000; 52: 630–4.
19. Woo YS, Lee JK, Oh SH et al. Role of SpyGlass peroral cholangioscopy in the evaluation of indeterminate biliary lesions. Dig Dis Sci 2014; 59: 2565–70.
20. Kim HJ, Kim MH, Lee SK et al. Tumor vessel: A valuable cholangioscopic clue of malignant biliary stricture. Gastrointest Endosc 2000; 52: 635–8.
21. Chen YK, Parsi MA, Binmoeller KF et al. Single-operator cholangioscopy in patients requiring evaluation of bile duct disease or therapy of biliary stones (with videos). Gastrointest Endosc 2011; 74: 805–14.
22. Korrapati P, Ciolino J, Wani S et al. The efficacy of peroral cholangioscopy for difficult bile duct stones and indeterminate strictures: a systematic review and meta-analysis. Endosc Int Open 2016; 4: E263–75.
23. Navaneethan U, Hasan MK, Kommaraju K et al. Digital, single-operator cholangiopancreatoscopy in the diagnosis and management of pancreatobiliary disorders: a multicenter clinical experience (with video). Gastrointest Endosc 2016; 84: 649–55.
24. Wadsworth CA, Westaby D, Khan SA. Endoscopic radiofrequency ablation for cholangiocarcinoma. Curr Opin Gastroenterol 2013; 29: 305–11.
25. Draganov PV, Chauhan S, Wagh MS et al. Diagnostic accuracy of conventional and cholangioscopy-guided sampling of indeterminate biliary lesions at the time of ERCP: A prospective, long-term follow-up study. Gastrointest Endosc 2012; 75: 347–53.
26. Roque J, Ho SH, Reddy N et al. Endoscopic ablation therapy for biliopancreatic malignancies. Clin Endosc 2015; 48: 15–9.
27. Tamada K, Kurihara K, Tomiyama T et al. How many biopsies should be performed during percutaneous transhepatic cholangioscopy to diagnose biliary tract cancer? Gastrointest Endosc 1999; 50: 653–8.
28. Choi HJ, Moon JH, Ko BM et al. Clinical feasibility of direct peroral cholangioscopyguided photodynamic therapy for inoperable cholangiocarcinoma performed by using an ultra-slim upper endoscope (with videos). Gastrointest Endosc 2011; 73: 808–13.
29. Zoepf T, Jakobs R, Arnold JC et al. Palliation of nonresectable bile duct cancer: Improved survival after photodynamic therapy. Am J Gastroenterol 2005; 100: 2426–30.
30. Ogura T, Onda S, Sano T et al. Evaluation of the safety of endoscopic radiofrequency ablation for malignant biliary stricture using a digital peroral cholangioscope (with videos). Dig Endosc 2017; 29: 712–7.
________________________________________________
1. Roca J, Flichtentrei R, Parodi M. Progress in the radiologic study of the biliary tract in surgery; cholangioscopy and cholangiography; utilization of apparatus; preliminary note. Dia Med 1951; 23: 3420.
2. Berci G. General surgery: endoscopic exploration (choledoscopy) of the biliary system at operation. West J Med 1977; 126: 388.
3. Rösch W, Koch H, Demling L. Peroral cholangioscopy. Endoscopy 1976; 8: 172–5.
4. Urakami Y, Seifert E, Butke H. Peroral Direct Cholangioscopy (PDCS) Using Routine Straight-view Endoscope: First Report. Endoscopy 1977;
9: 27–30.
5. Chen YK. Preclinical characterization of the SpyGlass peroral cholangiopancreatoscopy system for direct access, visualization, and biopsy. Gastrointest Endosc 2007; 65: 303–11.
6. Lee JH, Kim HW, Kang DH et al. Usefulness of percutaneous transhepatic cholangioscopic lithotomy for removal of difficult common bile duct stones. Clin Endosc 2013; 46: 65–70.
7. Ahmed O, Mathevosian S, Arslan B. Biliary interventions: tools and techniques of the trade, access, cholangiography, biopsy, cholangioscopy, cholangioplasty, stenting, stone extraction, and brachytherapy. Semin Intervent Radiol 2016; 33: 283–90.
8. Ishida Y, Itoi T, Okabe Y. Types of Peroral Cholangioscopy: how to choose the most suitable type of cholangioscopy. Curr Treat Options Gastroenterol 2016; 14: 210–9.
9. Franzini TA, Moura RN, de Moura EG. Advances in therapeutic cholangioscopy. Gastroenterol Res Pract 2016; 2016: 5249152.
10. Chen YK, Pleskow DK. SpyGlass single-operator peroral cholangiopancreatoscopy system for the diagnosis and therapy of bile duct disorders: a clinical feasibility study (with video). Gastrointest Endosc 2007; 65: 832–41.
11. Draganov PV, Lin T, Chauhan S et al. Prospective evaluation of the clinical utility of ERCP-guided cholangiopancreatoscopy with a new direct visualization system. Gastrointest. Endosc 2011; 73: 971–9.
12. Judah JR, Draganov PV. The use of SpyGlass Direct Visualization System in the management of pancreatobiliary disease. Diagnostic and therapeutic procedures in gastroenterology. Humana Press 2011: 195–209.
13. Pereira P, Peixoto A, Andrade P et al. Peroral cholangiopancreatoscopy with the SpyGlassR system: What do we know 10 years later. J Gastrointestin Liver Dis 2017; 26: 165–70.
14. Moon JH, Ko BM Choi HJ et al. Direct peroral cholangioscopy using an ultra-slim upper endoscope for the treatment of retained bile duct stones. Am J Gastroenterol 2009; 104: 2729–33.
15. Komanduri S, Thosani N, Abu Dayyeh BK et al. Cholangiopancreatoscopy. Gastrointest Endosc 2016; 84: 209–21.
16. Brauer BC, Chen YK, Shah RJ. Single-step direct cholangioscopy by freehand intubation using standard endoscopes for diagnosis and therapy of biliary diseases. Am J Gastroenterol 2012; 107: 1030–5.
17. Komanduri S, Thosani N, Abu Dayyeh BK et al. ASGE Technology Committee. Cholangiopancreatoscopy. Gastrointest Endosc 2016; 84: 209–21.
18. Seo DW, Lee SK, Yoo KS et al. Cholangioscopic findings in bile duct tumors. Gastrointest Endosc 2000; 52: 630–4.
19. Woo YS, Lee JK, Oh SH et al. Role of SpyGlass peroral cholangioscopy in the evaluation of indeterminate biliary lesions. Dig Dis Sci 2014; 59: 2565–70.
20. Kim HJ, Kim MH, Lee SK et al. Tumor vessel: A valuable cholangioscopic clue of malignant biliary stricture. Gastrointest Endosc 2000; 52: 635–8.
21. Chen YK, Parsi MA, Binmoeller KF et al. Single-operator cholangioscopy in patients requiring evaluation of bile duct disease or therapy of biliary stones (with videos). Gastrointest Endosc 2011; 74: 805–14.
22. Korrapati P, Ciolino J, Wani S et al. The efficacy of peroral cholangioscopy for difficult bile duct stones and indeterminate strictures: a systematic review and meta-analysis. Endosc Int Open 2016; 4: E263–75.
23. Navaneethan U, Hasan MK, Kommaraju K et al. Digital, single-operator cholangiopancreatoscopy in the diagnosis and management of pancreatobiliary disorders: a multicenter clinical experience (with video). Gastrointest Endosc 2016; 84: 649–55.
24. Wadsworth CA, Westaby D, Khan SA. Endoscopic radiofrequency ablation for cholangiocarcinoma. Curr Opin Gastroenterol 2013; 29: 305–11.
25. Draganov PV, Chauhan S, Wagh MS et al. Diagnostic accuracy of conventional and cholangioscopy-guided sampling of indeterminate biliary lesions at the time of ERCP: A prospective, long-term follow-up study. Gastrointest Endosc 2012; 75: 347–53.
26. Roque J, Ho SH, Reddy N et al. Endoscopic ablation therapy for biliopancreatic malignancies. Clin Endosc 2015; 48: 15–9.
27. Tamada K, Kurihara K, Tomiyama T et al. How many biopsies should be performed during percutaneous transhepatic cholangioscopy to diagnose biliary tract cancer? Gastrointest Endosc 1999; 50: 653–8.
28. Choi HJ, Moon JH, Ko BM et al. Clinical feasibility of direct peroral cholangioscopyguided photodynamic therapy for inoperable cholangiocarcinoma performed by using an ultra-slim upper endoscope (with videos). Gastrointest Endosc 2011; 73: 808–13.
29. Zoepf T, Jakobs R, Arnold JC et al. Palliation of nonresectable bile duct cancer: Improved survival after photodynamic therapy. Am J Gastroenterol 2005; 100: 2426–30.
30. Ogura T, Onda S, Sano T et al. Evaluation of the safety of endoscopic radiofrequency ablation for malignant biliary stricture using a digital peroral cholangioscope (with videos). Dig Endosc 2017; 29: 712–7.