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Визуальная оценка билиарных стриктур при пероральной холангиоскопии

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Цель. Оценить диагностическую точность визуальной оценки с помощью системы SpyGlass у пациентов с билиарными стриктурами неясного генеза.Материал и методы. С января 2021 по декабрь 2023 г. выполнено 33 транспапиллярных холангиоскопии с помощью системы SpyGlass. Все пациенты имели в анамнезе эпизоды механической желтухи и нуждались в визуальной оценке характера изменений в желчных протоках. В качестве основной аппаратуры применяли эндоскопическую видеосистему OLYMPUS EXERA III и видеодуоденоскоп TJF-Q180V. В качестве дочернего аппарата использовали систему SpyGlass DS II. Результаты. Из 33 пациентов женщин было 16 (48,4%), мужчин – 17 (51,6%), возраст больных варьировал от 45 до 71 года. Показанием к холангиоскопии была необходимость прицельной биопсии опухолей желчевыводящих путей и стриктур неясного генеза. Стриктуры были определены как злокачественные на основании следующих признаков: неравномерное расширение и извитость сосудов (неоваскуляризация), контактная кровоточивость, внутрипротоковые массы. Чувствительность и специфичность визуальной оценки с помощью системы SpyGlass составили 100 и 85,7%.Заключение. Пероральная холангиоскопия обладает высокой чувствительностью и специфичностью при визуальной интерпретации неопределенных билиарных поражений, что доказывает целесообразность ее использования в рутинной клинической практике.

Ключевые слова:
желчные протоки, опухолевая стриктура, неоангиогенез, транспапиллярная холангиоскопия, эндоскопия, SpyGlass, bile ducts, malignant stricture, neoangiogenesis, transpapillary cholangioscopy, endoscopy, SpyGlass

Литература:
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Visual assessment of biliary strictures in peroral cholangioscopy

Aim. To evaluate the diagnostic accuracy of visual assessment using the SpyGlass system in patients with biliary strictures of unknown origin.Materials and methods. From January 2021 to December 2023, 33 transpapillary cholangioscopies were performed using the SpyGlass system. All patients had a history of obstructive jaundice and required visual assessment of changes in the bile ducts. The primary equipment used included the OLYMPUS EXERA III endoscopic video system and the TJF-Q180V video duodenoscope. The SpyGlass DS II system was used as an accessory device.Results. Of the 33 patients, 16 (48.4%) were women and 17 (51.6%) were men. Patient age ranged from 45 to 71 years. The main indications for cholangioscopy were the need for targeted biopsy of biliary tract tumors and strictures of unknown origin. Strictures were classified as malignant based on the following visual criteria: irregular vessel dilation and vascular tortuosity (neovascularization), contact bleeding, and intraductal masses. The sensitivity and specificity of visual assessment using the SpyGlass system were 100% and 85.7%, respectively.Conclusion. Peroral cholangioscopy demonstrates high sensitivity and specificity in the visual interpretation of indeterminate biliary lesions, which proves its utility in routine clinical practice.

Keywords:
желчные протоки, опухолевая стриктура, неоангиогенез, транспапиллярная холангиоскопия, эндоскопия, SpyGlass, bile ducts, malignant stricture, neoangiogenesis, transpapillary cholangioscopy, endoscopy, SpyGlass