超声内镜引导下胰腺实性肿块细针穿刺术后急性胰腺炎：来自美国超声内镜中心的汇总分析

Acute pancreatitis after EUS-guided FNA of solid pancreatic masses: a pooled analysis from EUS centers in the United States.

作者信息

Eloubeidi Mohamad A, Gress Frank G, Savides Thomas J, Wiersema Maurits J, Kochman Michael L, Ahmad Nuzhat A, Ginsberg Gregory G, Erickson Richard A, Dewitt John, Van Dam Jacques, Nickl Nicholas J, Levy Michael J, Clain Jonathan E, Chak Amitabh, Sivak Michael V, Wong Richard, Isenberg Gerard, Scheiman James M, Bounds Brenna, Kimmey Michael B, Saunders Michael D, Chang Kenneth J, Sharma Ashish, Nguyen Phoniex, Lee John G, Edmundowicz Steven A, Early Dayna, Azar Riad, Etemad Babak, Chen Yang K, Waxman Irving, Shami Vanessa, Catalano Mark F, Wilcox C Mel

机构信息

Endoscopic Ultrasound Program, University of Alabama, 1530 3rd Avenue South, ZRB 636, Birmingham, AL 35294-0007, USA.

出版信息

Gastrointest Endosc. 2004 Sep;60(3):385-9. doi: 10.1016/s0016-5107(04)01714-6.

DOI:10.1016/s0016-5107(04)01714-6

PMID:15332028

Abstract

BACKGROUND

The aim of this study was to determine the frequency and the severity of pancreatitis after EUS-guided FNA of solid pancreatic masses. A survey of centers that offer training in EUS in the United States was conducted.

METHODS

A list of centers in which training in EUS is offered was obtained from the Web site of the American Society for Gastrointestinal Endoscopy. Designated program directors were contacted via e-mail. The information requested included the number of EUS-guided FNA procedures performed for solid pancreatic masses, the number of cases of post-procedure pancreatitis, and the method for tracking complications. For each episode of pancreatitis, technical details were obtained about the procedure, including the location of the mass, the type of fine needle used, the number of needle passes, and the nature of the lesion.

RESULTS

Nineteen of the 27 programs contacted returned the questionnaire (70%). In total, 4909 EUS-guided FNAs of solid pancreatic masses were performed in these 19 centers over a mean of 4 years (range 11 months to 9 years). Pancreatitis occurred after 14 (0.29%): 95% CI[0.16, 0.48] procedures. At two centers in which data on complications were prospectively collected, the frequency of acute pancreatitis was 0.64%, suggesting that the frequency of pancreatitis in the retrospective cohort (0.26%) was under-reported (p=0.22). The odds that cases of pancreatitis would be reported were 2.45 greater for the prospective compared with the retrospective cohort (95% CI[0.55, 10.98]). The median duration of hospitalization for treatment of pancreatitis was 3 days (range 1-21 days). The pancreatitis was classified as mild in 10 cases, moderate in 3, and severe in one; one death (proximate cause, pulmonary embolism) occurred after the development of pancreatitis in a patient with multiple comorbid conditions.

CONCLUSIONS

EUS-guided FNA of solid pancreatic masses is infrequently associated with acute pancreatitis. The procedure appears to be safe when performed by experienced endosonographers. The frequency of post EUS-guided FNA pancreatitis may be underestimated by retrospective analysis.

摘要

背景

本研究旨在确定超声内镜引导下实性胰腺肿块细针穿刺活检（EUS-FNA）术后胰腺炎的发生率及严重程度。对美国提供超声内镜培训的中心进行了一项调查。

方法

从美国胃肠内镜学会网站获取提供超声内镜培训的中心名单。通过电子邮件联系指定的项目主任。所要求的信息包括针对实性胰腺肿块进行的超声内镜引导下细针穿刺活检手术数量、术后胰腺炎病例数以及并发症追踪方法。对于每例胰腺炎发作，获取了有关手术的技术细节，包括肿块位置、使用的细针类型、穿刺次数以及病变性质。

结果

27个被联系的项目中有19个回复了问卷（70%）。在这19个中心，平均4年（范围11个月至9年）内共进行了4909例超声内镜引导下实性胰腺肿块细针穿刺活检。14例（0.29%，95%置信区间[0.16, 0.48]）术后发生胰腺炎。在两个前瞻性收集并发症数据的中心，急性胰腺炎发生率为0.64%，这表明回顾性队列中胰腺炎的发生率（0.26%）被低估了（p = 0.22）。与回顾性队列相比，前瞻性队列中报告胰腺炎病例的几率高2.45倍（95%置信区间[0.55, 10.98]）。胰腺炎治疗的中位住院时间为3天（范围1 - 21天）。10例胰腺炎被分类为轻度，3例为中度，1例为重度；1例患有多种合并症的患者在胰腺炎发生后死亡（直接原因，肺栓塞）。