Gabbrielli Armando, Pandolfi Monica, Mutignani Massimiliano, Spada Cristiano, Perri Vincenzo, Petruzziello Lucio, Costamagna Guido
Digestive Endoscopy Unit, Università Campus Bio Medico, Rome, Italy.
Gastrointest Endosc. 2005 Apr;61(4):576-81. doi: 10.1016/s0016-5107(05)00295-6.
The aim of endoscopic treatment in patients with chronic pancreatitis is to achieve decompression of the pancreatic duct, because duct obstruction with increased pressure within the duct is one of the leading causes of pain in these patients. The majority of patients suffer from relapsing pain, thus making it difficult to evaluate the efficacy of therapy. The outcome of endoscopic treatment on pain has been evaluated in patients with continuous pain (present for more than 1 month, at least 5 days per week, requiring daily analgesic therapy) and dilated duct.
Of 343 patients who underwent endotherapy for chronic pancreatitis in a 15-year period, 22 (6.4%)(19 men, mean age 48 years, alcohol abuse 14) had continuous pain and a dilated pancreatic duct.
Endotherapy was successful in all patients, with no procedure-related mortality and only mild complications. Pain disappeared, and analgesics could be discontinued in all patients immediately after endotherapy. Six patients are pain free after a mean period of 5.5 years. One pain-free patient died after 3.4 years from myocardial infarction. Five patients were successfully endoscopically re-treated for pain relapses. Four patients underwent surgery for frequent pain relapses after a mean period of 2.5 years. Six patients were lost to follow-up.
Endotherapy should be considered as the initial treatment of choice in patients with chronic pancreatitis, dilated duct, and continuous pain.
慢性胰腺炎患者内镜治疗的目的是实现胰管减压,因为胰管梗阻及管内压力升高是这些患者疼痛的主要原因之一。大多数患者遭受复发性疼痛,因此难以评估治疗效果。已对持续性疼痛(持续超过1个月,每周至少5天,需要每日镇痛治疗)且胰管扩张的患者进行了内镜治疗对疼痛影响的评估。
在15年期间接受慢性胰腺炎内镜治疗的343例患者中,22例(6.4%)(19例男性,平均年龄48岁,14例有酒精滥用史)有持续性疼痛且胰管扩张。
所有患者内镜治疗均成功,无手术相关死亡,仅有轻度并发症。治疗后所有患者疼痛消失,可立即停用镇痛药。6例患者平均5.5年后无疼痛。1例无疼痛患者在3.4年后死于心肌梗死。5例患者因疼痛复发成功接受内镜再治疗。4例患者平均2.5年后因频繁疼痛复发接受手术。6例患者失访。
对于慢性胰腺炎、胰管扩张且有持续性疼痛的患者,内镜治疗应被视为初始治疗的首选。