Keterangan
Cholangioscopy is an advanced endoscopic technique used for diagnosing and managing biliary diseases. It involves the insertion of a tiny camera into the bile duct to visualize and evaluate abnormalities. This procedure aids in the diagnosis of conditions like bile duct stones, strictures, and tumors. Cholangioscopy allows for direct visualization, biopsy, and therapeutic interventions in the bile ducts. It offers higher sensitivity and specificity compared to traditional imaging modalities in detecting biliary pathologies. Through cholangioscopy, precise and targeted treatments such as stone removal or stent placement can be performed. It plays a crucial role in guiding therapeutic decisions and optimizing patient outcomes. Cholangioscopy reduces the need for exploratory surgeries by providing detailed insights into biliary anatomy and pathology. Recent advancements in cholangioscopy technology have enhanced its diagnostic and therapeutic capabilities. Overall, cholangioscopy is a valuable tool in the comprehensive management of various biliary diseases, offering both diagnostic clarity and therapeutic interventions.
Ringkasan
- ERCP, a common GI intervention utilizing fluoroscopy, is generally effective for managing small stones and strictures. However, complex cases like large stones in the hepatic duct or long-segment CBD strictures often require advanced techniques like cholangioscopy. In these instances, standard ERCP methods may fail, necessitating direct visualization and tissue procurement under vision for accurate diagnosis and treatment.
- Cholangioscopy enables direct visualization of the biliary tract. Initially, direct cholangioscopy involved a single scope entering the duodenum, but indirect methods using dual or single-operator systems later emerged. The current preferred system is the "spy glass DS2" which boasts high-resolution imaging, a wide field of view, and a small diameter, allowing access even through tight strictures. It also includes a working channel for accessories like biopsy forceps and lithotripsy probes.
- The diagnostic indications for cholangioscopy include indeterminate bile duct structures, unexplained biliary dilation, and suspected malignant strictures or intraductal papillary neoplasms. It's especially valuable in assessing the true extent of cholangiocarcinoma for surgical planning and enabling targeted biopsies, improving accuracy compared to blind brush cytology. Distinguishing between malignant and inflammatory strictures can also be greatly aided by direct visual assessment.
- Therapeutic applications of cholangioscopy include laser lithotripsy for impacted stones, radiofrequency ablation (RFA) for tumors, selective bile duct cannulation, and retrieval of migrated stents. Key tools used in these procedures are biopsy forceps (spy bite), electro-hydraulic or laser lithotripsy probes, baskets, and snares. Lithotripsy mechanisms involve shock waves generated by either laser-induced fluid evaporation or electrical sparks, fragmenting stones into smaller pieces.
- Compared to conventional therapies, cholangioscopy-guided laser lithotripsy demonstrates superior CBD clearance rates for large bile duct stones. Open surgical exploration carries higher morbidity and isn't as readily available. EHL lithotripsy utilizes five pulses at a low power to protect the colangoscope and EHL probe for reuse.
- Notable cases demonstrated the benefits of cholangioscopy, including resolving hilar strictures caused by large stones initially misdiagnosed as malignant, and managing complex Mirizzi syndrome type IV cases involving stones eroding into the common bile duct. A primary risk associated with cholangioscopy is cholangitis.
Contoh Sertifikat
Tentang Pembicara
Dokter Jatin Yegurla
Consultant Gastroenterologist at Apollo Hospitals, Jubilee Hills, Hyderabad
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