Firoozi Babak, Choung Rosa, Diehl David L
NYU School of Medicine, Bellevue Hospital Center, New York, USA.
Gastrointest Endosc. 2003 Jul;58(1):127-30. doi: 10.1067/mge.2003.315.
Bile duct dilation in patients being treated by chronic narcotic substitution with methadone has been described but has not been systematically evaluated with ERCP. Retrograde cholangiographic findings in 6 patients taking methadone who were referred for evaluation of a dilated bile duct are described.
Six patients with chronic hepatitis (5 because of hepatitis C virus, 1 hepatitis B virus) who were taking methadone were evaluated by ERCP because of biliary dilation. Data were obtained regarding surgery, abdominal pain, weight loss, excessive ingestion of alcohol, liver disease, pancreatitis, and the dose and duration of methadone treatment.
ERCP revealed bile duct dilation without evidence of choledocholithiasis, stricture, or obstructing mass. There was one complication (postprocedure pain thought to be due to methadone withdrawal).
Chronic methadone use can lead to bile duct dilation without evidence of other significant pathology in asymptomatic patients. EUS may be safer than ERCP for evaluation of these patients, given that a need for therapeutic biliary intervention is unlikely.
已有关于接受美沙酮慢性替代治疗的患者出现胆管扩张的描述，但尚未通过内镜逆行胰胆管造影术（ERCP）进行系统评估。本文描述了6例因胆管扩张而接受ERCP检查的服用美沙酮患者的逆行胆管造影结果。
6例患有慢性肝炎（5例因丙型肝炎病毒，1例因乙型肝炎病毒）且正在服用美沙酮的患者因胆管扩张接受了ERCP检查。收集了有关手术、腹痛、体重减轻、过量饮酒、肝病、胰腺炎以及美沙酮治疗剂量和持续时间的数据。
ERCP显示胆管扩张，但未发现胆总管结石、狭窄或阻塞性肿块。出现了1例并发症（术后疼痛，认为是由于美沙酮戒断所致）。
在无症状患者中，长期使用美沙酮可导致胆管扩张，且无其他明显病变迹象。鉴于这些患者不太可能需要进行治疗性胆道干预，超声内镜检查（EUS）可能比ERCP更安全。
