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61.
Tsinrong Lee Thomas Zheng Jie Teng Vishal G Shelat 《World journal of gastrointestinal endoscopy》2021,13(12):571-592
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 choledo-choscopy 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. 相似文献
62.
Endoscopic management of difficult common bile duct stones: Where are we now? A comprehensive review
Alberto Tringali Deborah Costa Alessandro Fugazza Matteo Colombo Kareem Khalaf Alessandro Repici rea Anderloni 《World journal of gastroenterology : WJG》2021,27(44):7597-7611
Endoscopic management for difficult common bile duct (CBD) stones still presents a challenge for several reasons, including anatomic anomalies, patients’ individual conditions and stone features. In recent years, variable methods have emerged that have attributed to higher stone removal success rates, reduced cost and lower adverse events. In this review, we outline a stepwise approach in CBD stone management. As first line therapy, endoscopic sphincterotomy and large balloon dilation are recommended, due to a 30%-50% reduction of the use of mechanical lithotripsy. On the other hand, cholangioscopy-assisted lithotripsy has been increasingly reported as an effective and safe alternative technique to mechanical lithotripsy but remains to be reserved in special settings due to limited large-scale evidence. As discussed, findings suggest that management needs to be tailored to the patient’s characteristics and anatomical conditions. Furthermore, we evaluate the management of CBD stones in various surgical altered anatomy (Billroth II, Roux-en-Y and Roux-en-Y gastric bypass). Moreover, we could conclude that cholangioscopy-assisted lithotripsy needs to be evaluated for primary use, rather than following a failed management option. In addition, we discuss the importance of dissecting other techniques, such as the primary use of interventional endoscopic ultrasound for the management of CBD stones when other techniques have failed. In conclusion, we recognize that endoscopic sphincterotomy and large balloon dilation, mechanical lithotripsy and intraductal lithotripsy substantiate an indication to the management of difficult CBD stones, but emerging techniques are in rapid evolution with encouraging results. 相似文献
63.
Mohammad Elsayed Nariman Nezami Nima Kokabi Geoffrey M. Scriver Moataz M. Behairy Bill S. Majdalany 《Radiology Case Reports》2023,18(2):444
Endovascular coil erosion into the biliary system after hepatic artery embolization is a rare complication which may result in inflammation, strictures, choledocholithiasis, biliary colic, and cholangitis. Removal of coils may result in cessation of these symptoms, but is challenging in patients who cannot undergo removal via standard endoscopic approaches. This case report describes the retrieval of coils placed across a hepatic artery pseudoaneurysm, which over several years eroded into the biliary tree, resulting in calculi formation and post-prandial pain. Using combined fluoroscopy and cholangioscopy via percutaneous transhepatic accesses, the calculi were fragmented and the coils were retrieved, resulting in cessation of symptoms. 相似文献
64.
65.
经皮经肝胆道镜治疗医源性胆管损伤后再狭窄 总被引:1,自引:0,他引:1
目的探讨医源性胆管损伤后肝外胆管再狭窄的原因和治疗方法。方法对我院1998年1月~2005年1月12例(开腹胆囊切除术5例,腹腔镜胆囊切除术7例)医源性胆管损伤后肝外胆管再狭窄,建立经皮经肝通道,采用胆道镜取石、球囊扩张、支架管置入支撑扩张狭窄段胆管。结果8例用F20 Gruntzig型球囊导管扩张狭窄段胆管,2次即可放入6~8mm塑料支架引流管;4例球囊扩张3次后置入。塑料支架引流管置管6~12个月。12例随访2~3年,平均2.6年,无腹痛、发热、黄疸再次发作,B超、MRCP检查胆管无狭窄及再发结石。结论胆道镜取石、球囊扩张支架管置入治疗医源性胆管损伤后肝外胆管再狭窄创伤小,安全可行,效果良好。 相似文献
66.
腹腔镜联合胆道镜治疗胆总管结石的护理 总被引:1,自引:0,他引:1
目的:探讨腹腔镜联合胆道镜治疗胆总管结石的护理。方法:回顾分析72例胆囊结石合并胆总管结石患者行腹腔镜联合胆道镜治疗胆总管结石的临床资料,总结手术前后的生理、心理特点,术后的相关观察及护理。结果:20例未放置T导管,其中有10例腹腔引流良好,52例放置T导管,均未发生胆汁漏。所有患者均无并发症发生,术后恢复良好。结论:加强手术前的心理护理及术后相关并发症的观察及护理,对提高疗效有重要的作用。 相似文献
67.
Prinz C Weber A Goecke S Neu B Meining A Frimberger E 《World journal of gastrointestinal endoscopy》2014,6(1):20-26
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. Follow-up 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. 相似文献
68.
69.
Nimura Y 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2008,10(2):113-115
Peroral cholangioscopy (POCS) and percutaneous transhepatic cholangioscopy (PTCS) were first developed in the 1970s, and technical developments and clinical applications have taken place gradually ever since. POCS is used to diagnose small mucosal biliary lesions in non-icteric patients and early malignant changes in patients with persistent primary sclerosing cholangitis (PSC). Although PTCS is a more invasive diagnostic procedure than POCS, it has the advantage of precise diagnosis with mapping biopsy in defining the proximal and distal extension of superficially spreading cholangiocarcinoma (CCA) or mucin-producing CCA, which is predominantly found in papillary type CCA. POCS is significantly superior to ERCP in distinguishing between malignant and benign dominant bile duct stenoses in patients with PSC. The positive rate of PTCS biopsy for CCA is 96%, while morbidity and mortality of PTCS are 9% and 0%, respectively. Although magnetic resonance (MR) cholangiography may replace PTCS in determining the longitudinal spread of infiltrating type hilar CCA, the accuracy of MR cholangiography in papillary type hilar CCA is significantly lower than that of PTCS. 相似文献
70.
目的:探讨肝切除联合电子胆道镜治疗肝内胆管结石的疗效。方法:回顾性分析2004-01~2010-01经肝切除并联合术中及术后电子胆道镜治疗的186例肝内胆管结石病例。结果:186例患者均行相应的肝叶(段)切除和术中胆道镜取石,59例(31.7%)术后有残留结石,术后胆道镜残余结石总取净率为88.1%(52/59),186例患者总治愈率为96.2%(179/186),总残石率为3.8%(7/186)。结论:肝切除联合电子胆道镜是治疗肝内胆管结石的一种有效方法,电子胆道镜在治疗肝内胆管结石中起到了重要作用。 相似文献