Sato Daisuke, Shibahara Takeshi, Miyazaki Kaori, Matsui Hirohumi, Yanaka Akinori, Nakahara Akira, Tanaka Naomi
Department of Gastroenterology, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan.
Pancreas. 2005 Jul;31(1):93-7. doi: 10.1097/01.mpa.0000163175.52297.a6.
Endoscopic papillary balloon dilatation (EPBD) has been reported to increase the risk of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (4%-11%). Based on the hypothesis that performing endoscopic nasobiliary drainage (ENBD) could prevent this complication, we performed EPBD combined with ENBD (EPBD/ENBD) and analyzed the risk of pancreatitis.
Thirty-four patients underwent EPBD followed by ENBD for common bile duct stone(s). Serum amylase levels the following morning and incidence of pancreatitis were compared with those previously reported and with complications of simple diagnostic ERCP performed in our institution.
After EPBD/ENBD, amylase levels the following morning were 214.5 +/- 152.9 U/L, and no cases developed pancreatitis or hyperamylasemia (>3 times normal). These outcomes were favorable compared with previous EPBD reports. Furthermore, despite the stress of EPBD/ENBD after ERCP, these outcomes were better, even compared with simple ERCP performed at our institution [amylase levels: 318.7 +/- 475.2 U/L; hyperamylasemia: 16.5% (P = 0.006); pancreatitis: 7.1%].
Although EPBD has been regarded as a risk factor for post-ERCP pancreatitis, our results suggest the possibility that application of ENBD after EPBD decreases the incidence of pancreatitis and should be studied further. We speculate that ENBD itself prevents pancreatic duct obstruction by residual stones or papillary edema.
据报道，内镜下乳头球囊扩张术（EPBD）会增加内镜逆行胰胆管造影术（ERCP）后胰腺炎的风险（4%-11%）。基于内镜鼻胆管引流术（ENBD）可预防该并发症的假设，我们实施了EPBD联合ENBD（EPBD/ENBD）并分析了胰腺炎的风险。
34例患者因胆总管结石接受了EPBD，随后进行了ENBD。将次日上午的血清淀粉酶水平及胰腺炎发生率与先前报道的结果以及在我们机构进行的单纯诊断性ERCP的并发症进行比较。
EPBD/ENBD后，次日上午的淀粉酶水平为214.5±152.9 U/L，无病例发生胰腺炎或高淀粉酶血症（>正常上限3倍）。与先前的EPBD报道相比，这些结果较为理想。此外，尽管ERCP后进行EPBD/ENBD会带来应激，但这些结果甚至比在我们机构进行的单纯ERCP更好[淀粉酶水平：318.7±475.2 U/L；高淀粉酶血症：16.5%（P = 0.006）；胰腺炎：7.1%]。
尽管EPBD一直被视为ERCP后胰腺炎的一个危险因素，但我们的结果表明，EPBD后应用ENBD有可能降低胰腺炎的发生率，应进一步研究。我们推测，ENBD本身可预防残留结石或乳头水肿导致的胰管梗阻。
