超声证实III型胆总管囊肿，内镜下针刀分割治疗

Q3 Medicine

VideoGIE Pub Date : 2025-03-25 DOI:10.1016/j.vgie.2025.03.035

Amirah Etchegaray MD, BBiomedSc , Sanjivan Mudaliar MD, BSc, FRACP , Benedict Devereaux MBBS, MPhil, FRACP, FACG, FGESA

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引用次数: 0

摘要

背景和目的III型胆总管囊肿由胆总管十二指肠内部分的囊性扩张组成，是最罕见的亚型，恶性风险低。传统上，胆总管囊肿的治疗方法是手术切除或内镜下胆总管囊肿开窗，通过原生乳头插管囊肿，并使用括约肌切开术进行有袋化。我们描述了一种新的方法来管理一个IIIA型胆总管囊肿内镜针刀分割和有袋化的IIIA型胆总管囊肿。方法一名19岁男性非吸烟者，5年间歇性绞痛性胃脘痛病史，MRCP确诊为大（69 × 53 × 89 mm） IIIA型胆总管囊肿。十二指肠镜检查显示一个大的下垂肿块，伴有十二指肠明显的内侧移位和间歇性胃出口梗阻，妨碍了远端乳头的清晰显示。经过多学科团队的仔细讨论，我们决定在内镜下进行针刀分割和有袋化手术，以减少胆汁淤积和进一步形成导管结石的机会。结果采用徒手技术，使用ENDO CUT I （30 W, 3d 3i）进行针刀分割。为了对囊肿进行减压，在囊肿的管腔侧面从下向上做了一个大切口。进一步切开使囊肿腔有袋化，使囊性内容物完全引流到十二指肠。患者对手术的耐受性良好，术后无出血。连续影像学显示大胆总管囊肿完全消退，最后随访（术后12个月）无不良事件发生。结论内镜下针刀分割有袋化术是治疗症状性胆总管结石的有效新方法；然而，需要更多的数据来评估这种方法的长期安全性。

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Endosonographically confirmed type III choledochal cyst managed with endoscopic needle-knife division

Background and Aims

Type III choledochal cysts consist of a cystic dilatation of the intraduodenal portion of the common bile duct and represent the rarest subtype, with a low risk of malignancy. Traditionally, choledochoceles are treated with surgical resection or endoscopic choledochal cyst fenestration with cannulation of the cyst via the native papilla and marsupialization using a sphincterotome. We describe a novel approach to management of a type IIIA choledochal cyst with endoscopic needle-knife division and marsupialization of a type IIIA choledochal cyst.

Methods

A 19-year-old male nonsmoker with a 5-year history of intermittent, colicky epigastric pain was referred to our tertiary center for management of a large (69 × 53 × 89 mm) type IIIA choledochal cyst confirmed on MRCP. Duodenoscopy revealed a large pendulous mass, with significant medial displacement of the duodenum and intermittent gastric outlet obstruction, that prevented clear visualization of the distally located papilla. After careful multidisciplinary team discussion, it was decided that endoscopic needle-knife division and marsupialization would be undertaken to reduce biliary stasis and the chance of further ductal stone formation.

Results

Needle-knife division was performed using a freehand technique using ENDO CUT I (30 W, 3d 3i). To decompress the cyst, a large incision was made from the inferior to superior position on the luminal aspect of the cyst. Further incisions were made to marsupialize the cyst cavity and allow complete drainage of the cystic content into the duodenum. The patient tolerated the procedure well, with no bleeding postprocedure. Serial imaging demonstrated complete resolution of the large choledochal cyst, with no adverse events at last follow-up (12 months after the procedure).

Conclusions

Endoscopic needle-knife division and marsupialization is an effective novel approach for the treatment of symptomatic choledochoceles; however, more data are required to evaluate the long-term safety of this approach.

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来源期刊

VideoGIE Medicine-Gastroenterology

CiteScore

1.50

自引率

0.00%

发文量

132

审稿时长

105 days

期刊介绍： VideoGIE, an official video journal of the American Society for Gastrointestinal Endoscopy, is an Open Access, online-only journal to serve patients with digestive diseases. VideoGIE publishes original, single-blinded peer-reviewed video case reports and case series of endoscopic procedures used in the study, diagnosis, and treatment of digestive diseases. Videos demonstrate use of endoscopic systems, devices, and techniques; report outcomes of endoscopic interventions; and educate physicians and patients about gastrointestinal endoscopy. VideoGIE serves the educational needs of endoscopists in training as well as advanced endoscopists, endoscopy staff and industry, and patients. VideoGIE brings video commentaries from experts, legends, committees, and leadership of the society. Careful adherence to submission guidelines will avoid unnecessary delays, as incomplete submissions may be returned to the authors before initiation of the peer review process.