| 1 | Comparative analysis of ERCP,IDUS,EUS and CT in predicting malignant bile duct strictures显示文摘AIM:To compare endoscopic retrograde cholangio-pancreatography(ERCP),intraductal ultrasound(IDUS),endosonography(EUS),endoscopic transpapillary forceps biopsies(ETP)and computed tomography(CT)with respect to diagnosing malignant bile duct strictures.METHODS:A patient cohort with bile duct strictures of unknown etiology was examined by ERCP and IDUS,ETP,EUS,and CT.The sensitivity,specificity,and accuracy rates of the diagnostic procedures were calculated based on the definite diagnoses proved by histopathology or long-term follow-up in those patients who did not undergo surgery.For each of the diagnostic measures,the sensitivity,specificity,and accuracy rates were calculated.In all cases,the gold standard was the histopathologic staging of specimens or long-term follow-up of at least 12 mo.A comparison of the accuracy rates between the localization of strictures was performed by using the Mann-Whitney U-test and theχ2test as appropriate.A comparison of the accuracy rates between the diagnostic procedures was performed by using the McNemar’s test.Differences were considered statistically significant if P<0.05.RESULTS:A total of 234 patients(127 males,107 females,median age 64,range 20-90 years)with indeterminate bile duct strictures were included.A total of 161patients underwent operative exploration;thus,a surgical histopathological correlation was available for those patients.A total of 113 patients had malignant disease proven by surgery;in 48 patients,benign disease was surgically found.In these patients,the decision for surgical exploration was made due to the suspicion of malignant disease in multimodal diagnostics(ERCP,CT,or EUS).Fifty patients had a benign diagnosis and were followed by a surveillance protocol with a followup of at least 12 mo;the median follow-up was 34 mo.Twenty-three patients had extended malignant disease,and thus were considered palliative.A comparison of the different diagnostic tools for detecting bile duct malignancy resulted in accuracy rates of 91%(ERCP/IDUS),59%(ETP),92%(IDUS+ETP),74%(EUS),and 73%(CT),respectively.In the subgroup analysis,the accuracy rates(%,ERCP+IDUS/ETP/IDUS+ETP;EUS;CT)for each tumor entity were as follows:cholangiocellular carcinoma:92%/74%/92%/70%/79%;pancreatic carcinoma:90%/68%/90%/81%/76%;and ampullary carcinoma:88%/90%/90%/76%/76%.The detection rate of malignancy by ERCP/IDUS was superior to ETP(91%vs 59%,P<0.0001),EUS(91%vs74%,P<0.0001)and CT(91%vs 73%,P<0.0001);EUS was comparable to CT(74%vs 73%,P=0.649).When analyzing accuracy rates with regard to localization of the bile duct stenosis,the accuracy rate of EUS for proximal vs distal stenosis was significantly higher for distal stenosis(79%vs 57%,P<0.0001).CONCLUSION:ERCP/IDUS is superior to EUS and CT in providing accurate diagnoses of bile duct strictures of uncertain etiology.Multimodal diagnostics is recommended. | Hauke S Heinzow Sara Kammerer Carina Rammes Johannes Wessling Dirk Domagk Tobias Meister | 2014 | World Journal of Gastroenterology2014，20，30： | 14 |
| 3 | 探头式共聚焦激光显微内镜在胆管狭窄中的诊断价值显示文摘目的探讨探头式共聚焦激光显微内镜(probe-based confocal laser endomicroscopy,pCLE)在性质不明胆管狭窄临床诊断中的作用。方法纳入2013年4月1日-2016年12月30日在杭州市第一人民医院行pCLE检查和细胞刷检的12例性质不明胆管狭窄患者,收集患者的临床资料、经内镜逆行胰胆管造影术检查结果、pCLE检查图像、细胞刷检病理结果,以术后组织病理及12个月以上的随访情况为最终诊断,分别计算pCLE和细胞刷检诊断胆管恶性狭窄的灵敏度、特异度、阳性预测值、阴性预测值、总体准确率。结果12例患者最终诊断为9例恶性肿瘤,3例良性狭窄。细胞刷检诊断胆管恶性狭窄的灵敏度为3/9,特异度为3/3,阳性预测值为3/3,阴性预测值为3/9,总体准确率为50.0%(6/12)。pCLE诊断胆管恶性狭窄的灵敏度为9/9,特异度为2/3,阳性预测值为9/10,阴性预测值为2/2,总体准确率为91.7%(11/12)。结论pCLE可用于性质不明胆管狭窄的鉴别诊断。 | 方晓焱 金杭斌 楼奇峰 张筱凤 杨建锋 | 2021 | 中华消化内镜杂志2021，38，3： | 0 |
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