Alazmi Waleed M, Mosler Patrick, Watkins James L, McHenry Lee, Fogel Evan L, Sherman Stuart, Lehman Glen A
Indiana University Medical Center, Indianapolis, IN 46202, USA.
J Clin Gastroenterol. 2007 Apr;41(4):422-6. doi: 10.1097/01.mcg.0000225686.75582.04.
Minor papilla (MP) cannulation remains difficult in some patients despite improved cannulation devices and techniques. Therefore, noninvasive methods to predict presence of pancreas divisum (Pdiv) are desired. If Pdiv could be recognized before any cannulation is attempted, appropriate attention could be focused on MP cannulation and prolonged major papilla attempt at pancreatogram can be avoided.
To evaluate whether simple inspection of the MP during initial duodenal entry during endoscopic retrograde cholangiopancreatography (ERCP) can predict the presence of Pdiv.
Patients undergoing ERCP with intended pancreatic duct cannulation were included in the study. Assessment of the MP was made during a 30 to 60-second period of inspection including aspiration of duodenal luminal air with the endoscope. The probability of Pdiv based on the appearance of the MP was then estimated by assessing the size of the MP, the diameter of MP orifice, and whether juice was seen draining through the MP orifice.
Two hundred and twelve patients were prospectively analyzed. The most common indications for ERCP were suspected sphincter of Oddi dysfunction (44.3%) and idiopathic pancreatitis (34.4%). Pancreatograms revealed Pdiv in 42 (19.8%). The MP appearance had 54.7% sensitivity and 90% specificity in detecting Pdiv (positive predictive value 57.5%, negative predicting value 88.9%). Seventy percent of the false positive patients had an obstructing pathology at the ventral duct that would explain the MP appearance.
Certain features of the MP (enlarged papilla, open orifice) had a moderate predictive value for the presence of Pdiv or an obstruction at the major papilla. However, a significant number of patients with Pdiv did not have these features.
尽管插管设备和技术有所改进，但在一些患者中，小乳头（MP）插管仍然困难。因此，需要采用非侵入性方法来预测胰腺分裂（Pdiv）的存在。如果在尝试任何插管之前就能识别出Pdiv，就可以将适当的注意力集中在MP插管上，避免在胰管造影时过长时间地尝试大乳头插管。
评估在内镜逆行胰胆管造影（ERCP）初始进入十二指肠期间对MP进行简单检查是否能预测Pdiv的存在。
纳入计划进行胰管插管的ERCP患者。在内镜检查的30至60秒内对MP进行评估，包括用内镜抽吸十二指肠腔内空气。然后通过评估MP的大小、MP开口直径以及是否看到有胰液从MP开口流出，来估计基于MP外观的Pdiv可能性。
对212例患者进行了前瞻性分析。ERCP最常见的适应证是怀疑Oddi括约肌功能障碍（44.3%）和特发性胰腺炎（34.4%）。胰管造影显示42例（19.8%）存在Pdiv。MP外观在检测Pdiv方面的敏感性为54.7%，特异性为90%（阳性预测值57.5%，阴性预测值88.9%）。70%的假阳性患者在腹侧胰管有梗阻性病变，这可以解释MP的外观。
MP的某些特征（乳头增大、开口开放）对Pdiv的存在或大乳头梗阻具有中等预测价值。然而，相当数量的Pdiv患者没有这些特征。
