Venu Rama P, Brown Russell D, Halline Allan G
Department of Medicine, Section of Digestive and Liver Diseases, University of Illinois at Chicago, 840 South Wood Street, Chicago, IL 60612, U.S.A.
J Clin Gastroenterol. 2002 May-Jun;34(5):560-8. doi: 10.1097/00004836-200205000-00017.
Endoscopic retrograde cholangiopancreatography (ERCP) plays a pivotal role in the management of patients with acute and chronic pancreatitis. Whereas endoscopic observation during ERCP permits recognition of abnormalities involving the major and minor duodenal papillae such as papillary tumors or choledochocele, radiographic evaluation enables the detection of structural abnormalities of pancreaticobiliary ducts like strictures or calculi. Sphincter of Oddi manometry, a technical advance of ERCP, is essential for the diagnosis of sphincter of Oddi dysfunction, which may present clinically as recurrent pancreatitis. Because structural alterations of the pancreatic duct forms the hallmark of chronic pancreatitis, ERCP is highly sensitive and specific in diagnosing chronic pancreatitis. Apart from its diagnostic role, ERCP offers a variety of possibilities for therapeutic interventions in selected problems associated with pancreatitis. Endoscopic papillectomy and mucosal resection for tumors of the papilla, unroofing of a choledochocele, and sphincterotomy for sphincter ablation in sphincter of Oddi dysfunction are some of the therapeutic interventions possible during ERCP. Pancreatic ductal hypertension, which is considered to be the major pathophysiologic mechanism for disabling abdominal pain in chronic pancreatitis, also can be managed by ERCP-directed treatments. Pancreatic sphincterotomy, dilation of strictures, lithotripsy, extraction of calculi, and deployment of endoprosthesis constitute the commonly used therapeutic techniques in this situation. Besides offering a noninvasive alternative, these treatments are associated with a favorable clinical outcome comparable with that of operative treatments. Nevertheless, complications such as acute pancreatitis, bleeding, perforation, or sepsis may occur in 5% to 10% of patients undergoing these procedures. Therefore, careful selection of patients, appropriate preoperative care, and a team approach, including surgeon, interventional radiologist, and endoscopist, are important.
内镜逆行胰胆管造影术（ERCP）在急慢性胰腺炎患者的治疗中起着关键作用。ERCP过程中的内镜观察可识别涉及十二指肠乳头（包括乳头肿瘤或胆总管囊肿）的异常情况，而影像学评估能够检测胰胆管的结构异常，如狭窄或结石。Oddi括约肌测压是ERCP的一项技术进步，对于诊断可能表现为复发性胰腺炎的Oddi括约肌功能障碍至关重要。由于胰管的结构改变是慢性胰腺炎的标志，ERCP在诊断慢性胰腺炎方面具有高度敏感性和特异性。除了其诊断作用外，ERCP还为与胰腺炎相关的特定问题提供了多种治疗干预的可能性。内镜下乳头切除术和乳头肿瘤的黏膜切除术、胆总管囊肿开窗术以及Oddi括约肌功能障碍时用于括约肌切除的括约肌切开术是ERCP期间可能的一些治疗干预措施。胰管高压被认为是慢性胰腺炎导致致残性腹痛的主要病理生理机制，也可通过ERCP指导的治疗来处理。胰括约肌切开术、狭窄扩张术、碎石术、结石取出术和内置假体置入是这种情况下常用的治疗技术。这些治疗方法除了提供一种非侵入性的替代方案外，还具有与手术治疗相当的良好临床效果。然而，接受这些手术的患者中可能有5%至10%会发生急性胰腺炎、出血、穿孔或败血症等并发症。因此，仔细选择患者、适当的术前护理以及包括外科医生、介入放射科医生和内镜医生在内的团队协作很重要。
