Testoni P A, Caporuscio S, Bagnolo F, Lella F
Department of Biomedical Sciences, University of Milan, IRCCS San Raffaele Hospital, Italy.
Am J Gastroenterol. 2000 Jul;95(7):1702-7. doi: 10.1111/j.1572-0241.2000.02292.x.
In about 30% of cases, the etiology of acute recurrent pancreatitis remains unexplained, and the term "idiopathic" is currently used to define such disease. We aimed to evaluate the long-term outcome of patients with idiopathic recurrent pancreatitis who underwent endoscopic cholangiopancreatography (ERCP) followed by either endoscopic biliary (and seldom pancreatic) sphincterotomy or ursodeoxycholic acid (UDCA) treatment, in a prospective follow-up study.
A total of 40 consecutive patients with intact gallbladder entered the study protocol after a 24-month observation period during which at least two episodes of pancreatitis occurred. All patients underwent diagnostic ERCP, followed by biliary or minor papilla sphincterotomy in cases of documented or suspected bile duct microlithiasis and sludge, type 2 sphincter of Oddi dysfunction, or pancreas divisum with dilated dorsal duct. Patients with no definite anatomical or functional abnormalities received long-term treatment with UDCA. After biliary sphincterotomy, patients with further episodes of pancreatitis underwent main pancreatic duct stenting followed by pancreatic sphincterotomy if the stent had proved to be effective.
ERCP found an underlying cause of pancreatitis in 70% of cases. Patients were followed-up for a period ranging from 27 to 73 months. Effective therapeutic ERCP or UDCA oral treatment proved that occult bile stone disease and type 2 or 3 sphincter of Oddi dysfunction (biliary or pancreatic segment) had been etiological factors in 35 of the 40 cases (87.5%) After therapeutic ERCP or UDCA, only three patients still continued to have episodes of pancreatitis.
Diagnostic and therapeutic ERCP and UDCA were effective in 92.5% of our cases, over a long follow-up, indicating that the term "idiopathic" was justified only in a few patients with acute recurrent pancreatitis.
在约30%的病例中，急性复发性胰腺炎的病因仍不明，目前“特发性”一词用于定义此类疾病。在一项前瞻性随访研究中，我们旨在评估接受内镜逆行胰胆管造影（ERCP），随后行内镜下胆管（很少行胰管）括约肌切开术或熊去氧胆酸（UDCA）治疗的特发性复发性胰腺炎患者的长期预后。
40例胆囊完好的连续患者在经过24个月的观察期（期间至少发生两次胰腺炎发作）后进入研究方案。所有患者均接受诊断性ERCP，若有记录或怀疑存在胆管微结石和胆泥、2型Oddi括约肌功能障碍或伴有扩张的背侧胰管的胰腺分裂症，则行胆管或小乳头括约肌切开术。未发现明确解剖或功能异常的患者接受UDCA长期治疗。胆管括约肌切开术后，胰腺炎再次发作的患者接受主胰管支架置入术，若支架证明有效，则随后行胰管括约肌切开术。
ERCP在70%的病例中发现了胰腺炎的潜在病因。患者随访时间为27至73个月。有效的治疗性ERCP或UDCA口服治疗证明，隐匿性胆石病和2型或3型Oddi括约肌功能障碍（胆管或胰管段）是40例患者中35例（87.5%）的病因。治疗性ERCP或UDCA治疗后，只有3例患者仍继续有胰腺炎发作。
在长期随访中，诊断性和治疗性ERCP以及UDCA在我们92.5%的病例中有效，表明“特发性”一词仅在少数急性复发性胰腺炎患者中适用。
