Biliyer Darlık ve Zor Biliyer Taş Tedavisinde Yeni Nesil Dijital Kolanjiyoskopi Kullanımı

Year 2020, Volume: 6 Issue: 1, 59 - 64, 12.01.2020

Sadettin Hülagü , Göktuğ Şirin

https://doi.org/10.30934/kusbed.656893

Abstract

Amaç:
SpyGlass fiberoptik versiyonunun, standart endoskopik retrograd
kolanjiyopankreatografi (ERCP) işlemine kıyasla tanı koyma ve tedavi etme
yeterliliğinin çok daha fazla olduğu kanıtlanmıştır. Kolanjiyo-pankreatoskopik
inceleme için kullanıma yeni giren SpyGlass Dijital (D-SpG) versiyonu, bu eski
modelin kullanım zorluğu ve görüntü kalitesindeki yetersizliklerinin üstesinden
gelinmesi için geliştirilmiştir. Ülkemizde bu modeli ilk olarak kullanan klinik
olarak, kullanım ile ilgili deneyimlerimizi paylaşmak istedik.

Yöntem: Bu
çalışma, yapılan işlemlerin ve hastalara ait özelliklerin prospektif olarak
girildiği hasta kayıt sistemindeki verilerin, retrospektif olarak
değerlendirildiği, tek merkezli bir çalışmadır. Tanımlanmamış biliyer darlığı
veya standart yöntemler ile tedavisi yapılamamış biliyo-pankreatik taşları olan
ve 18 yaşından büyük hastalar incelendi. Bu hasta grubunda olup, D-SpG ile
işlem yapılan hastalarda, işlem başarısı ve işlem güvenirliliği değerlendirildi.
İşlem başarısı, taş olan vakalar için taşların tam olarak temizlenmesi, taş
dışı vakalarda ise SpyGlass kataterin hedef noktaya ilerletilerek, yeterli
görüntü alınması ve gereken tanısal ya da terapötik işlemin yapılabilmesi
olarak tanımlandı.

Bulgular:
Toplamda, 22 hastaya 24 işlem yapılmıştı. D-SpG sistemi vakaların tamamında
başarılı idi. Taş dışı endikasyon ile işlem yapılan hastalarda başarı oranı
%100 (14/14) idi. Biliyer taşı olan hastalarda, tam olarak taş temizliğine 5
hastada (%100) bir seansta ulaşıldı. Pankreatoskopi 3 hastada uygulandı ve
2’sinde başarılı oldu. Sadece bir hastada kolanjit gözlendi (% 4,1).

Sonuç:
SpyGlass dijital versiyonu, deneyimli ellerde, kolanjiopankreatokopi yapılması
için güvenli ve başarılı bir şekilde kullanılabilir. 

Keywords

Kolanjiyoskopi, dijital kolanjiyoskopi, ERCP, indetermine darlık, zor biliyer taş

The Use of New Generation Digital Cholangioscopy to Treat Biliary Stenosis and Difficult Biliary Stone

Abstract

Objective:
SpyGlass fiberoptic version has proved to be much more capable of diagnosing
and treating than the standard endoscopic retrograd cholangiopancreatography
(ERCP) procedure. The newly introduced SpyGlass Digital (D-SpG) version for
cholangio-pancreatoscopic examination has been developed to overcome the
difficulty and poor image quality of this old model. As the first clinic using
this model in our country, we wanted to share our experience.

Methods: This
is a single-center study in which the data were evaluated retrospectively in
the registration system, where the procedures and the characteristics of the
patients were prospectively entered. Patients who were older than 18 years of
age with undefined biliary stenosis or biliyo-pancreatic stones who could not
be treated with standard methods were evaluated. In this group of patients who
were treated with D-SpG, the success and safety of the procedure were
evaluated.The success of the procedure was defined as complete removal of
stones in stone cases, and as sufficient image of the area of interest by
SpyGlass catheter carrying forward to the target point, and successful
applications of diagnostic or therapeutic maneuvers in non-stone cases.

Results: In
total, 24 procedures were performed on 22 patients. The D-SpG system was
successful in all of the cases. Success rate was 100% (14/14) in patients
treated with non-stone indication. In patients with biliary Stone, complete
stone cleaning was achieved in one session in 5 patients (100%). Pancreatoscopy
was performed in 3 patients and was successful in 2. Cholangitis was observed
in only one patient (4.1%).

Conclusion: The
digital version of SpyGlass can be used safely and successfully, in experienced
hands, to perform cholangiopancreatoscopy.

Keywords

Cholangioscopy, digital cholangioscopy, ERCP, indetermine stricture, difficult biliary stone

References

• Nakajima M, Akasaka Y, Yamaguchi K, Fujimoto S, Kawai K. Direct endoscopic visualization of the bile and pancreatic duct systems by peroral cholangiopancreatoscopy (PCPS). Gastrointest Endosc. 1978;24:141-145.
• Ponchon T, Gagnon P, Valette PJ, Henry L, Chavaillon A, Thieulin F. Pulsed dye laser lithotripsy of bile duct stones. Gastroenterology. 1991;100:1730-1736.
• Chen YK, Pleskow DK. SpyGlass single-operator peroral cholangiopancreatoscopy system for the diagnosisi and therapy of bile-duct disorders:a clinical feasibility study (with video). Gastrointest Endosc. 2007;65:832-841.
• Draganov PV, Lin T, Chauhan S, Wagh MS, Hou W, Forsmark CE. Prospective evaluation of the clinical utility of ERCP-guided cholangiopancreatoscopy with a new direct visualization system. Gastrointest Endosc. 2011;73:971-979.
• Parsi MA, Jang S, Sanaka M, Stevens T, Vargo JJ. Diagnostic and therapeutic cholangiopancreatoscopy:performance of a new digital cholangioscope. Gastrointest Endosc. 2014;79:936-942.
• Shah RJ, Neuhaus H, Parsi M, Reddy DN, Pleskow DK. A randomized assessment of a semidisposable, fiberoptic single-operator cholangioscope with a fullydisposable, digital single-operator cholangioscope in a biliary tract bench model. United European Gastroenterol J. 2015;3(5S):146-687.
• Hülagü S, Şirin G, Duman AE, Yılmaz H. Use of SpyGlass for peroral cholangioscopy in the diagnosis and treatment of hepatobiliary diseases in over five years follow-up: A single center experience. Turk J Gastroenterol. 2019;30:1044-1054.
• Judah JR, Draganov PV. Intraductal biliary and pancreatic endoscopy: an expanding scope of possibility. World J Gastroenterol. 2008;14:3129-3136.
• Fritcher EG, Kipp BR, Halling KC, et al. A multivariable model using advanced cytologic methods for the evaluation of indeterminate pancreatobiliary strictures. Gastroenterology. 2009;136:2180-2186.
• de Bellis M, Fogel EL, Sherman S, et al. Influence of stricture dilation and repeat brushing on the cancer detection rate of brush cytology in the evaluation of malignant biliary obstruction. Gastrointest Endosc. 2003;58:176-182.
• 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;74:805-814.
• Draganov PV, Evans W, Fazel A, Forsmark CE. Large size balloon dilation of the ampulla after biliary sphincterotomy can facilitate endoscopic extraction of difficult bile duct stones. J Clin Gastroenterol. 2009;43:782-786.
• Attasaranya S, Cheon YK, Vittal H, et al. Large-diameter biliary orifice balloon dilation to aid in endoscopic bile duct stone removal: a multicenter series. Gastrointest Endosc. 2008;67:1046-1052.
• Patel SN, Rosenkranz L, Hooks B, et al. Holmium-yttrium aluminum garnet laser lithotripsy in the treatment of biliary calculi. Gastrointest Endosc. 2014;79:344-348.
• Seelhoff A, Schumacher B, Neuhaus H. Prospective study of SpyGlass guided laser lithotripsy of bile duct stones after failure of conventional endoscopic techniques [abstract]. Gastrointest Endosc. 2009;69:AB261.
• Attwell AR, Patel S, Kahaleh M, et al. ERCP with per-oral pancreatoscopy-guided laser lithotripsy for calcific chronic pancreatitis: a multicenter U.S. experience. Gastrointest Endosc. 2015;82:311-318.