Fuchs M, Schepp W
Klinik für Gastroenterologie, Hepatologie und Gastroenterologische Onkologie, Klinikum Bogenhausen, Städtisches Klinikum München GmbH, Englschalkinger Str. 77, 81925, München, Deutschland.
Radiologe. 2008 Aug;48(8):721-4; 726-31. doi: 10.1007/s00117-008-1668-z.
Endoscopic retrograde pancreatography (ERP) and endoscopic ultrasound (EUS) are superior to cross-sectional imaging procedures for detection of low-grade pancreatitis, but detection of duct alterations is more reliable by middle and high-grade chronic pancreatitis than by low-grade. In addition to assessment of alterations in the pancreatic duct, EUS also allows detection of parenchymatous alterations. Because of the risk of post-ERP pancreatitis, ERP has been mostly eliminated from diagnostic procedures. In contrast, endoscopic retrograde cholangiopancreatography (ERCP) allows an unrivalled access to interventional treatment of inflammatory alterations of the biliopancreatic duct system, by retrograde, non-penetrable papillae even in the rendezvous procedure with EUS-assisted probing of the Ductus Wirsungianus. Despite the technical success of endoscopic procedures, surgical duct decompression has proven to be superior for relief from pancreatitic pain. Biliary drainage is also more likely to be successful on a permanent basis using surgical procedures than by repeat multi-stenting, at least by calcifying pancreatitis. Peroral transgastral transmural therapy of postpancreatitic necroses opens up further options over surgical removal of necroses.
内镜逆行胰胆管造影术（ERP）和内镜超声检查（EUS）在检测轻度胰腺炎方面优于横断面成像检查，但在检测导管改变方面，中重度慢性胰腺炎比轻度慢性胰腺炎更可靠。除了评估胰管改变外，EUS还能检测实质改变。由于存在ERP后胰腺炎的风险，ERP在诊断程序中大多已被淘汰。相比之下，内镜逆行胆胰管造影术（ERCP）通过逆行、不可穿透的乳头，即使在与EUS辅助探查胰管的会师操作中，也能无与伦比地进入胆胰管系统炎症改变的介入治疗。尽管内镜手术技术上取得了成功，但手术导管减压已被证明在缓解胰腺炎疼痛方面更具优势。至少对于钙化性胰腺炎，使用手术方法进行胆道引流比重复多次置入支架更有可能永久成功。经口经胃壁透壁治疗胰腺坏死为手术切除坏死组织开辟了更多选择。
