Preliminary exploration of SpyGlass direct visualization system in diagnosis and treatment of biliary stricture after liver transplantation
10.3969/j.issn.1674-7445.2022.01.009
- VernacularTitle:SpyGlass直视系统在肝移植术后胆道狭窄诊治中的初步探索
- Author:
Dong ZHAO
1
;
Zhuo ZHANG
;
Yiming HUANG
;
Yi ZHANG
;
Taishi FANG
;
Xin JIN
;
Kangjun ZHANG
;
Xu YAN
;
Xinchen ZENG
;
Nan JIANG
Author Information
1. Shenzhen Third People's Hospital, National Clinical Research Center for Infectious Diseases, Shenzhen 518000, China
- Publication Type:Research Article
- Keywords:
Liver transplantation;
Biliary stricture;
Biliary dilatation;
Biliary calculi;
SpyGlass direct visualization system;
Color Doppler ultrasound;
Magnetic resonance cholangiopancreatography(MRCP);
Endoscopic retrograde cholangiopancreatography(ERCP)
- From:
Organ Transplantation
2022;13(1):55-
- CountryChina
- Language:Chinese
-
Abstract:
Objective To preliminarily evaluate the application value of SpyGlass direct visualization system in the diagnosis and treatment of biliary stricture after liver transplantation. Methods Clinical data of 4 patients presenting with biliary stricture after liver transplantation who underwent SpyGlass direct visualization system examination were collected. The examination, treatment and prognosis of biliary stricture were analyzed. Results The examination results of color Doppler ultrasound, magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) in 4 patients suggested biliary anastomotic stricture with intrahepatic biliary dilatation, and 2 of them were complicated with intrahepatic biliary calculi. Repeated placement of biliary stent under ERCP yielded poor effect in 3 cases. SpyGlass direct visualization system examination hinted biliary anastomotic stricture in 4 patients, 3 cases of intrahepatic biliary dilatation, 3 cases of intrahepatic biliary calculi, 2 cases of purulent bile and 3 cases of floccules within the biliary tract, 1 case of congestion and edema of biliary tract wall and 2 cases of local epithelial necrosis and stiffness changes of intrahepatic biliary tract wall. The wire could not be inserted in 1 patient due to severe biliary anastomotic stricture. Four patients were treated with biliary stricture resection + biliary stone removal + biliary end-to-end anastomosis, biliary stricture resection + biliary-intestinal anastomosis, ERCP lithotomy + biliary metal stent implantation, and biliary metal stent implantation + percutaneous transhepatic bile duct lithotomy, respectively. Relevant symptoms were relieved without evident complications. All patients survived during the follow-up until the submission date. Conclusions Compared with traditional imaging examination, SpyGlass direct visualization system may more directly display the morphological characteristics of biliary tract wall and structural changes within biliary tract cavity, which is an effective examination tool for biliary stricture after liver transplantation. In addition, individualized treatment methods may be adopted for different biliary tract diseases, which is expected to improve clinical prognosis of patients.
