日本のプライオリティー：経口的直接胆管鏡

 

Y Uno

 

 

 

1977：ドイツ（日本）

Endoscopy. 1977 Mar;9(1):27-30.

Peroral direct cholangioscopy (PDCS) using routine straight-view endoscope: first report.

Urakami Y, Seifert E, Butke H.

Abstract

A new endoscopic method, the peroral direct cholangioscopy (PDCS) is described. A prograde fiberscope of 8.8 mm diameter can be directly inserted, without using a second scope as a guide, into the biliary system after EPT (endoscopic papillotomy). The lumen of the common bile duct is observed entirely and exactly. The image is excellent. Also acessories may be inserted into the duct via the biopsy channel under direct control.

 

 

1980：日本

Endoscopy. 1980 Jan;12(1):30-7.

Peroral cholangiopancreatoscopy (PCPS) and peroral direct cholangioscopy (PDCS).

Urakami Y.　2nd Dept. of Internal Medicine, School of Medicine, Tokushima University, Japan

Abstract

Peroral cholangiopancreatoscopy (PCPS) using a mother and babyscope was attempted in 30 cases and the duct systems were successfully inspected in 25 cases. This procedure should be useful in cases with biliary and pancreatic diseases if the bending system and biopsy channel of the babyscope can be improved. Peroraldirect cholangioscopy (PDCS) using four kinds of forward-viewing small-caliber fiberscopes was successfully employed in 14 of 22 cases. These instruments have a biopsy channel as well as an air-supplying and an aspiration channel, so that a stone can be removed with a basket catheter under visual control. PDCS should become valuable therapeutically in bile duct diseases if the fiberscope can be improved.

 

 

2006：小児用電子スコープ：米国

Gastrointest Endosc. 2006 May;63(6):853-7.

Endoscopic direct cholangioscopy by using an ultra-slim upper endoscope: a feasibility study.

Larghi A, Waxman I.

Section of Endoscopy and Therapeutics, and the Cancer Research Center, The University of Chicago, Chicago, Illinois 60637, USA.

Abstract

BACKGROUND:

The search for an easier and less cumbersome technique to perform direct visual examination of the biliary tree is still underway.

OBJECTIVE:

To assess the feasibility of performing endoscopic direct cholangioscopy utilizing an ultra-slim upper endoscope designed for pediatric patients.

DESIGN:

Prospective, observational, pilot study.

SETTING:

Tertiary referral center.

PATIENTS:

Three patients who underwent endoscopic retrograde cholangiography for evaluation and treatment of choledocholithiasis.

METHODS:

Following the completion of the endoscopic retrograde cholangiography, a 0.035-inch diameter super-stiff Jagwire (Boston Scientific Corp, Natick, Mass) was placed in the common bile duct. Using the wire to maintain access, we removed the duodenoscope and backloaded the wire onto an ultra-slim upper endoscope (GIF-XP 160, Olympus America Inc, Melville, NY), which was advanced over the guidewire under fluoroscopic and endoscopic control into the duodenum and then across the ampulla of Vater into the common bile duct and upstream.

RESULTS:

Endoscopic direct cholangioscopy was attempted and successfully completed in all 3 patients. One patient was found to have persistent large amount of sludge and stones, and was referred for surgery. In the other two patients, endoscopic direct cholangioscopy demonstrated complete duct clearance, obviating the need for stent placement and repeat endoscopic retrograde cholangiography procedures.

LIMITATIONS:

Small sample size, pilot study.

CONCLUSIONS:

Endoscopic direct cholangioscopy with an ultra-slim upper endoscope originally designed for pediatric use is feasible. Future advances in endoscope development, as well as specifically designed accessories, could lead to the next generation of intraductal diagnosis and therapy.

 

2007：経鼻用電子スコープ：日本

日本消化器病学会雑誌
Nihon Shokakibyo Gakkai Zasshi. 2007 Nov;104(11):1614-24.

[Peroral direct cholangioscopy for diagnosis and treatment].

Uno Y, Nagaoka Y, Okuda K, Kamishima Y, Ohkuro S, Shimokuni T, Aoki T, Hamada H, Takada J, Kachiki Y.

Abstract

Peroral direct cholangioscopy (PDCS) is endoscopic method for diagnosis in the common bile duct (CBD) utilizing an ultra-slim upper endoscope. Clinical utility and problem of this method were investigated in ten patients who had stenosis or obstruction in the CBD with stones or a tumor. Scope shaft had to become the form of a U loop by counterclockwise rotation, to advance the scope in the direction of intrahepatic bile duct. As for one case, although the scope was formed alpha loop without U loop, direct observation of total CBC was possible. Large working channel of the endoscope could take adequate tissue sample by large biopsy forceps. Electrohydraulic lithotripsy and stone extraction with a basket could be accomplished easily and safely by direct visualization with a clear image. Pneumobilia was noted in all cases with insertion of PDCS. Although the abdominal pain and pyrexia with regard to PDCS did not occur, transient leukocytosis was noted.

https://www.jstage.jst.go.jp/article/nisshoshi/104/11/104_11_1614/_article/-char/ja/

 
以前にアップしたYouTubeです。
Endoscopic Direct Cholangioscopyではなく、
Peroral direct cholangioscopyです。
修正しようとしましたが、その当時のパスワードを忘れ、
さらに、元データも紛失したので、再アップできません。
口から入れた内視鏡で、
胆管の石を粉々に砕ける状況をご覧ください。



































内視鏡の手技は基本的に右回転です。
しかし、胆管に挿入する場合には、
反時計回転にして、スコープを引くのがポイントです。



問題点は、回転でスコープのシャフトの付け根が壊れやすいことです。
また、スコープが抜けやすいことも問題です。

そのため、側視鏡とガイドワイヤーで固定して、
その脇から細径スコープを挿入する方法があります。
側視鏡は固定するためだけに使用するため、
光源を切り替えれば、システムは1台で可能です。