BİLİYER DARLIK VE ZOR BİLİYER TAŞ TEDAVİSİNDE YENİ NESİL DİJİTAL KOLANJİYOSKOPİ KULLANIMI

Amaç: SpyGlass fiberoptik versiyonunun, standart endoskopik retrograd kolanjiyopankreatografi (ERCP) işlemine kıyasla tanı koyma ve tedavietme yeterliliğinin çok daha fazla olduğu kanıtlanmıştır. Kolanjiyo-pankreatoskopik inceleme için kullanıma yeni giren SpyGlass Dijital (D-SpG)versiyonu, bu eski modelin kullanım zorluğu ve görüntü kalitesindeki yetersizliklerinin üstesinden gelinmesi için geliştirilmiştir. Ülkemizde bumodeli ilk olarak kullanan klinik olarak, kullanım ile ilgili deneyimlerimizi paylaşmak istedik.Yöntem: Bu çalışma, yapılan işlemlerin ve hastalara ait özelliklerin prospektif olarak girildiği hasta kayıt sistemindeki verilerin, retrospektif olarakdeğerlendirildiği, tek merkezli bir çalışmadır. Tanımlanmamış biliyer darlığı veya standart yöntemler ile tedavisi yapılamamış biliyo-pankreatiktaşları olan ve 18 yaşından büyük hastalar incelendi. Bu hasta grubunda olup, D-SpG ile işlem yapılan hastalarda, işlem başarısı ve işlemgüvenirliliği değerlendirildi. İşlem başarısı, taş olan vakalar için taşların tam olarak temizlenmesi, taş dışı vakalarda ise SpyGlass kataterin hedefnoktaya ilerletilerek, yeterli görüntü alınması ve gereken tanısal ya da terapötik işlemin yapılabilmesi olarak tanımlandı.Bulgular: Toplamda, 22 hastaya 24 işlem yapılmıştı. D-SpG sistemi vakaların tamamında başarılı idi. Taş dışı endikasyon ile işlem yapılanhastalarda başarı oranı %100 (14/14) idi. Biliyer taşı olan hastalarda, tam olarak taş temizliğine 5 hastada (%100) bir seansta ulaşıldı. Pankreatoskopi3 hastada uygulandı ve 2’sinde başarılı oldu. Sadece bir hastada kolanjit gözlendi (% 4,1).Sonuç: SpyGlass dijital versiyonu, deneyimli ellerde, kolanjiopankreatokopi yapılması için güvenli ve başarılı bir şekilde kullanılabilir.

THE USE OF NEW GENERATION DIGITAL CHOLANGIOSCOPY TO TREAT BILIARY STENOSIS AND DIFFICULT BILIARY STONE

Objective: SpyGlass fiberoptic version has proved to be much more capable of diagnosing and treating than the standard endoscopic retrograd cholangiopancreatography (ERCP) procedure. The newly introduced SpyGlass Digital (D-SpG) version for cholangio-pancreatoscopic examination has been developed to overcome the difficulty and poor image quality of this old model. As the first clinic using this model in our country, we wanted to share our experience. Methods: This is a single-center study in which the data were evaluated retrospectively in the registration system, where the procedures and the characteristics of the patients were prospectively entered. Patients who were older than 18 years of age with undefined biliary stenosis or biliyopancreatic stones who could not be treated with standard methods were evaluated. In this group of patients who were treated with D-SpG, the success and safety of the procedure were evaluated.The success of the procedure was defined as complete removal of stones in stone cases, and as sufficient image of the area of interest by SpyGlass catheter carrying forward to the target point, and successful applications of diagnostic or therapeutic maneuvers in non-stone cases. Results: In total, 24 procedures were performed on 22 patients. The D-SpG system was successful in all of the cases. Success rate was 100% (14/14) in patients treated with non-stone indication. In patients with biliary Stone, complete stone cleaning was achieved in one session in 5 patients (100%). Pancreatoscopy was performed in 3 patients and was successful in 2. Cholangitis was observed in only one patient (4.1%). Conclusion: The digital version of SpyGlass can be used safely and successfully, in experienced hands, to perform cholangiopancreatoscopy.

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