进行肝活检的不同方法:核心技术设置和对这些方法的最新理解

IF 4.4 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Chao Sun, Xingliang Zhao, Lei Shi, Xiaofei Fan, Xiaolong Qi
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引用次数: 0

摘要

全球多种肝脏疾病的发病率急剧上升,因此,诊断和分期这些病理实体的需求尚未得到满足,这预示着肝活检(LB)技术的广泛应用。肝活检的方法多种多样,包括经皮肝活检、经颈静脉肝活检以及最近出现的微创方法,即 EUS 引导下的肝活检(EUS-LB)。在这篇综述文章中,我们得出的结论是,在局灶性、浸润性和实质性肝病患者中,EUS-LB 可作为经皮 LB 和经颈静脉 LB 的一种可行、可靠和安全的替代方法,其诊断率更高,取样效果更佳,不良反应也可得到控制。此外,EUS-LB 模式的几个技术支柱,如穿刺针大小/类型的选择、活检针的引流方式以及通过/启动技术的选择,都在不断优化和改进,目的是获得更好的标本数量和质量。EUS 引导模式的另一个优势和独特性是可以将多种筛查、监测和干预程序合并到一次内窥镜检查中。因此,一些试点研究通过将 EUS-LB 与门静脉压力梯度的同步测量或肝脏硬度的检查相结合,明确了其临床实用性。然而,还需要进行更多的研究,特别是随机对照试验或真实世界的证据,以阐明 EUS-LB 作为常规/例行肝病管理的有效性和安全性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Distinct ways to perform a liver biopsy: The core technique setups and updated understanding of these modalities
There is dramatically increased incidence of several liver diseases worldwide; thus, an unmet need to diagnose and stage these pathological entities heralds the wide application of liver biopsy (LB) techniques. The ways of LB are versatile, including percutaneous LB, transjugular LB, and more recently an approach of minimal invasiveness, that is, EUS-guided LB (EUS-LB). In this review article, we come to the conclusion that EUS-LB may serve as a feasible, reliable, and safe alternative to percutaneous LB and transjugular LB in terms of improved diagnostic yield, excellent sampling performance, and controlled adverse events among patients with focal, infiltrative, and parenchymal liver diseases. Furthermore, extensive efforts have been made to optimize and refine several technical pillars within EUS-LB modality such as the selection of needle size/type, priming manner of biopsy needle, and choice of pass/actuation technique, all of which aim at obtaining better specimen quantity and quality. Another advantageous aspect and unique property pertinent to EUS-guided modality indicate that multiple screening, surveillance, and intervention procedures can be combined into one single endoscopic session. Accordingly, some pilot studies have clarified the clinical usefulness by integrating EUS-LB with simultaneous measurement of portal pressure gradient or examination of liver stiffness. However, more studies, in particular, randomized controlled trials or real-world evidence, are practically warranted to elucidate the validity and safety of EUS-LB as a regular/routine part of managing liver diseases.
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来源期刊
Endoscopic Ultrasound
Endoscopic Ultrasound GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
6.20
自引率
11.10%
发文量
144
期刊介绍: Endoscopic Ultrasound, a publication of Euro-EUS Scientific Committee, Asia-Pacific EUS Task Force and Latin American Chapter of EUS, is a peer-reviewed online journal with Quarterly print on demand compilation of issues published. The journal’s full text is available online at http://www.eusjournal.com. The journal allows free access (Open Access) to its contents and permits authors to self-archive final accepted version of the articles on any OAI-compliant institutional / subject-based repository. The journal does not charge for submission, processing or publication of manuscripts and even for color reproduction of photographs.
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