Testoni Pier Alberto
Division of Gastroenterology and Gastrointestinal Endoscopy, University Vita-Salute San Raffaele, IRCCS San Raffaele Hospital, Milan, Italy.
JOP. 2002 Nov;3(6):195-201.
The reported incidence of post-ERCP/sphincterotomy pancreatitis ranges between 1.3 and 24.4% in non-selected series. This varying incidence likely reflects on the one hand difference in patient populations, indications and endoscopic expertise and, on the other hand, different definitions of pancreatitis and methods of data collection. Among a number of patient-related factors recognized at risk for post-ERCP pancreatitis in four recent large prospective studies, the combination of female gender, normal serum bilirubin levels and recurrent abdominal pain suggesting sphincter of Oddi dysfunction and previous post-ERCP pancreatitis placed patients at an increasingly higher risk of pancreatitis. Among the technique-related risk factors for post-ERCP pancreatitis, biliary sphincter balloon dilation, difficult cannulation, sphincter of Oddi manometry and pancreatic sphincterotomy have also been recognized as significant risk factors. However, since the case mix in non-selected series does not significantly differ in the different studies, it is logical to assume that the different criteria adopted for defining the post-ERCP pancreatitis play a key role in the reported wide variation of incidence reported for this complication. The occurrence and duration of pain and the amplitude of serum amylase after ERCP are critical points in the definition of post-ERCP pancreatitis. Although a consensus conference identified 24-hour persisting pain associated with hyperamylasemia greater than 3 times the upper reference limit as an indicator of pancreatitis, these two parameters are however considered in a different manner in the studies available up to now. In a prospective study where we calculated the incidence of post-ERCP pancreatitis by using the most widely used criteria, for both occurrence and duration of pancreatic pain and serum amylase amplitude, the incidence of post-procedure pancreatitis ranged from 1.9 to 11.7% depending on the criteria adopted.
在未选择病例的系列研究中，报道的内镜逆行胰胆管造影术（ERCP）/括约肌切开术后胰腺炎的发生率在1.3%至24.4%之间。这种发生率的差异一方面可能反映了患者群体、适应证和内镜专业技术的不同，另一方面也反映了胰腺炎定义和数据收集方法的差异。在最近四项大型前瞻性研究中确定的与ERCP术后胰腺炎风险相关的一些患者因素中，女性、血清胆红素水平正常、提示Oddi括约肌功能障碍的复发性腹痛以及既往ERCP术后胰腺炎这些因素同时存在时，患者发生胰腺炎的风险会越来越高。在与ERCP术后胰腺炎相关的技术风险因素中，胆管括约肌球囊扩张、插管困难、Oddi括约肌测压和胰管括约肌切开术也被认为是重要的风险因素。然而，由于不同研究中未选择病例系列的病例组合差异不大，因此可以合理推测，用于定义ERCP术后胰腺炎的不同标准在报道的该并发症发生率的广泛差异中起关键作用。ERCP术后疼痛的发生和持续时间以及血清淀粉酶水平是定义ERCP术后胰腺炎的关键点。尽管一次共识会议确定持续24小时的疼痛且血淀粉酶升高超过正常上限值3倍作为胰腺炎的指标，但在目前已有的研究中，这两个参数的考量方式有所不同。在一项前瞻性研究中，我们使用最广泛应用的标准计算ERCP术后胰腺炎的发生率，对于胰腺疼痛的发生和持续时间以及血清淀粉酶水平，术后胰腺炎的发生率根据所采用的标准在1.9%至11.7%之间。
