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基于针的共聚焦激光显微内镜用于超声内镜引导细针穿刺胰腺病的的首次评估

发布日期:2014-1-29 12:40:23 文章来源:GIE 作者次数:1244
    基于针的共聚焦激光显微内镜用于超声内镜引导细针穿刺胰腺病的的首次评估
     
    背景
    使用超声内镜引导细针穿刺(EUS - FNA)的难题包括抽样误差,非诊断性细胞学以及有限的现场细胞学评价。基于原型针共聚焦激光显微内镜(nCLE)的探针是亚毫米波探测器,它通过细针穿刺在微观层面提供实时成像。
     
    目的
    为了评估基于针的共聚焦激光显微内镜在胰腺病变中行超声内镜引导细针穿刺的可行性。
     
    设计
    可行性研究。
     
    背景
    多中心三级护理。
     
    患者
    18例患者行超声内镜引导细针穿刺。
     
    干预
    给患者注射2.5毫升10%的荧光素。 病灶由定位于19号活检针尖端的基于针的共聚焦激光显微内镜探头检查。
     
    主要结果测量
    设备的完整性,技术的简便性,安全性及图像采集。
     
    结果
    本研究病例中包括16例囊肿和2例包块。研究过程中未发生设备故障。18例中有2例在尝试图像采集中遇到技术难题,这反映了如后负荷技术,较长的铁套管尖端和一种经十二指肠的途径等难关。18例患者中有17例在超声内镜引导细针穿刺过程中实现了基于针的共聚焦激光显微内镜技术成像的技术。10例有很好的图像质量。两例发生严重不良事件,且都是胰腺炎需住院治疗。
     
    局限性
    有限的样本大小,病理诊断证实的患者数量少,缺乏注记的病理和影像。
     
    结论
    在超声內镜引导下通过一枚19号针对胰腺病人行基于针的共聚焦激光显微内镜技术是可行的。 未来的研究将需说明构造鉴别,诊断准确率和并发症概况。胰腺炎的发生率需要进一步证实和缓解。
     
    缩写词:CEA,癌胚抗原;CLE,共聚焦激光显微内镜;EUS-FNA,超声内镜引导细针穿刺;IPMN,导管内乳头状黏液性肿瘤;nCLE,基于针的共聚焦激光显微内镜;pCLE,基于探针的共聚焦激光显微内镜
     
     
     
    First assessment of needle-based confocal laser endomicroscopy during EUS-FNA procedures of the pancreas
    Background
    Challenges in EUS-guided FNA (EUS-FNA) include sampling error, nondiagnostic cytology, and limited on-site cytological evaluation. A prototype needle-based confocal laser endomicroscopy (nCLE) probe is a submillimeter probe that provides real-time imaging at the microscopic level through the FNA needle.
    Objective
    To evaluate the feasibility of nCLE during EUS-FNA of pancreatic lesions.
    Design
    Feasibility study.
    Setting
    Multicenter, tertiary care.
    Patients
    Eighteen patients presenting for EUS-FNA.
    Interventions
    Patients were injected with 2.5 mL of 10% fluorescein. The lesion was interrogated with the nCLE probe positioned at the tip of a 19-gauge FNA needle.
    Main Outcome Measurements
    Device integrity, technical ease, safety, and image acquisition.
    Results
    Cases included 16 cysts and 2 masses. There were no device malfunctions. Technical challenges were encountered in 6 of 18 attempts to image and reflected challenges with a postloading technique, the longer ferule tip, and a transduodenal approach. Technical feasibility to perform imaging with nCLE during a pancreatic EUS-FNA procedure was achieved in 17 of 18 cases. Ten cases had good to very good image quality. Two serious adverse events occurred; both were pancreatitis requiring hospitalization.
    Limitations
    Limited sample size, small number of patients with confirmed pathological diagnosis, lack of coregistered pathology and images.
    Conclusions
    nCLE in the pancreas is technically feasible via a 19-gauge needle under endosonographic guidance. Future studies will address identification of structures, diagnostic accuracy, and complication profiles. The rate of pancreatitis needs to be further clarified and mitigated.
    (作者:)
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