Repiso Ortega Alejandro, Gómez-Rodríguez Rafael, González de Frutos Concepción, de la Cruz Pérez Gema, Navajas Javier, Pérez Grueso María José, Carrobles José María
Servicio de Aparato Digestivo, Hospital Virgen de la Salud, Toledo, Spain.
Gastroenterol Hepatol. 2008 Apr;31(4):207-12. doi: 10.1157/13117921.
The aim of this study was to evaluate the utility of endoscopic ultrasonography in the etiological diagnosis of patients initially diagnosed with acute idiopathic pancreatitis and to determine the clinical and laboratory factors related to the results of this technique.
We studied 73 patients initially diagnosed with acute idiopathic pancreatitis and referred to our service for biliopancreatic endoscopic ultrasonography. A positive result was considered to be identification of at least one possible cause of pancreatitis, excluding patients in whom the only echoendoscopic finding was chronic pancreatitis. The clinical characteristics and clinical course of these patients were compared with the results of the technique.
Endoscopic ultrasonography diagnosed at least one possible cause of acute pancreatitis in 32 patients (44%). The most frequent diagnoses were cholelithiasis (16%) and biliary sludge (20%). The diagnostic yield of endoscopic ultrasonography was lower in patients with prior cholecystectomy (16% vs. 49%; p=0.037) while a positive result was more likely in patients with elevated glutamyl oxaloacetic transaminase (GOT) or glutamyl pyruvic transaminase (GPT) levels at diagnosis of acute pancreatitis (GOT: 68 vs. 31%; p=0.002; GPT: 63 vs. 26%; p=0.001). No differences were found in diagnostic yield according to whether endoscopic ultrasonography was performed during the first episode of pancreatitis (48%) or in recurrent episodes (37%) (p=0.40). Over a mean follow-up period of 28 months, recurrence of new episodes of pancreatitis was significantly lower in patients with an etiological diagnosis (3 vs. 22%; p=0.02).
Endoscopic ultrasonography is a useful technique in the etiological diagnosis of acute pancreatitis of unknown origin, especially in patients with elevated transaminase levels and/or without cholecystectomy. This technique should be used in the first episode of acute idiopathic pancreatitis.
本研究的目的是评估内镜超声在最初诊断为急性特发性胰腺炎患者的病因诊断中的效用，并确定与该技术结果相关的临床和实验室因素。
我们研究了73例最初诊断为急性特发性胰腺炎并转诊至我们科室接受胆胰内镜超声检查的患者。阳性结果被认为是识别出至少一种可能的胰腺炎病因，不包括那些唯一的超声内镜检查发现为慢性胰腺炎的患者。将这些患者的临床特征和临床病程与该技术的结果进行比较。
内镜超声在32例患者（44%）中诊断出至少一种可能的急性胰腺炎病因。最常见的诊断是胆石症（16%）和胆泥（20%）。既往有胆囊切除术的患者内镜超声诊断率较低（16%对49%；p=0.037），而在急性胰腺炎诊断时谷草转氨酶（GOT）或谷丙转氨酶（GPT）水平升高的患者中更可能获得阳性结果（GOT：68%对31%；p=0.002；GPT：63%对26%；p=0.001）。根据内镜超声检查是在胰腺炎首次发作期间（48%）还是复发期间（37%）进行，诊断率没有差异（p=0.40）。在平均28个月的随访期内，病因诊断明确的患者胰腺炎新发作的复发率显著较低（3%对22%；p=0.02）。
内镜超声在不明原因急性胰腺炎的病因诊断中是一种有用的技术，尤其是在转氨酶水平升高和/或未行胆囊切除术的患者中。该技术应在急性特发性胰腺炎的首次发作时使用。
