Hyodo Naoko, Hyodo Takafumi
General Division I, Department of Image Diagnosis, Omiya Medical Center, Jichi Medical School, 1-847 Amanuma-cho, 330-8503 Saitama, Japan.
J Gastroenterol. 2003;38(12):1155-61. doi: 10.1007/s00535-003-1223-7.
The concept of autoimmune-related pancreatitis (AIP) has recently been described. It is important to exclude pancreaticobiliary malignancy in patients with AIP who develop distal bile duct strictures. The aim of this study was to evaluate distal common bile duct strictures in AIP patients by endoscopic ultrasonography (EUS), intraductal ultrasonography (IDUS), and contrast-enhanced EUS (ceEUS).
Five patients with AIP, encountered from January 2000 through December 2001, underwent EUS, IDUS, and ceEUS, using Levovist as a contrast medium. EUS and ceEUS were used to follow changes in distal bile duct strictures in three of these five patients following a trial of steroid therapy.
Of the five patients, four had cholestatic biochemical profiles, three were positive for autoantibodies, and three had elevated serum immunoglobulin G (IgG) or IgG4. A diffusely enlarged pancreas, narrowing of the main pancreatic duct (MPD), and strictured common bile duct in the pancreatic head were features common to all patients. Pretherapy EUS or IDUS imaging showed concentric wall thickening of the distal common bile duct causing bile duct stenosis. ceEUS showed diffuse strong enhancement of the thickened bile duct wall, possibly due to inflammation. After the steroid therapy, the stenotic lesions in both the MPD and distal common bile duct were rapidly attenuated, with a decline in biochemical cholestatic enzymes and serum IgG or IgG4 levels.
On EUS and IDUS imaging, concentric bile duct wall thickening and its strong enhancement by Levovist was characteristic in AIP patients.
自身免疫性胰腺炎（AIP）的概念最近已被描述。对于发生远端胆管狭窄的AIP患者，排除胰胆管恶性肿瘤很重要。本研究的目的是通过内镜超声检查（EUS）、导管内超声检查（IDUS）和对比增强EUS（ceEUS）评估AIP患者的远端胆总管狭窄情况。
2000年1月至2001年12月期间收治的5例AIP患者接受了EUS、IDUS和ceEUS检查，使用Levovist作为对比剂。在这5例患者中的3例接受类固醇治疗试验后，使用EUS和ceEUS观察远端胆管狭窄的变化。
5例患者中，4例有胆汁淤积的生化指标，3例自身抗体呈阳性，3例血清免疫球蛋白G（IgG）或IgG4升高。所有患者均有胰腺弥漫性肿大、主胰管狭窄和胰头部胆总管狭窄的特征。治疗前的EUS或IDUS成像显示远端胆总管壁呈同心性增厚，导致胆管狭窄。ceEUS显示增厚的胆管壁弥漫性强烈增强，可能是由于炎症所致。类固醇治疗后，主胰管和远端胆总管的狭窄病变迅速减轻，胆汁淤积酶和血清IgG或IgG4水平下降。
在EUS和IDUS成像中，AIP患者的特征是胆管壁同心性增厚及其被Levovist强烈增强。
