Department of Gastroenterology, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
Gastrointest Endosc. 2010 Jan;71(1):85-90. doi: 10.1016/j.gie.2009.08.008.
Intrapancreatic bile duct stricture in autoimmune pancreatitis (AIP) is usually diagnosed as sclerosing cholangitis even if the stricture is limited to the intrapancreatic area. However, it is not known whether compression caused by pancreatic edema or biliary wall thickening causes such a biliary stricture.
Our purpose was to clarify the factor that contributes to intrapancreatic biliary stricture in AIP: pancreatic head lesion or biliary wall thickening.
Single-center retrospective study.
This study was performed in a tertiary care academic medical center.
Fifty-six patients with AIP were included.
The relationship between the presence of a pancreatic head lesion and intrapancreatic biliary stricture was examined. In addition, the relationship between the extent of the intrapancreatic biliary stricture and the wall thickening was evaluated.
Among 44 patients with a pancreatic head lesion, 41 (93%) had intrapancreatic bile duct stricture. Among 12 patients without a pancreatic head lesion, only 2 had such a stricture (P < .0001). Intraductal US showed average intrapancreatic biliary wall thickening with severe stricture of 2.7 +/- 1.0 mm, significantly thicker than that with mild stricture (1.9 +/- 0.35 mm; P = .0200).
Intraductal US was not performed in all patients.
Both pancreatic edema and biliary wall thickening influenced intrapancreatic biliary stricture in AIP. This type of stricture should be differentiated from extrapancreatic biliary stricture that may be caused by biliary wall thickening only.
自身免疫性胰腺炎（AIP）中的胰内胆管狭窄通常被诊断为硬化性胆管炎，即使狭窄仅限于胰内区域。然而，尚不清楚引起这种胆管狭窄的原因是胰腺水肿还是胆管壁增厚所致。
我们旨在阐明 AIP 中胰内胆管狭窄的原因：胰头部病变还是胆管壁增厚。
单中心回顾性研究。
本研究在一家三级保健学术医疗中心进行。
纳入 56 例 AIP 患者。
检查胰头部病变与胰内胆管狭窄之间的关系。此外，还评估了胰内胆管狭窄的程度与胆管壁增厚之间的关系。
在 44 例有胰头部病变的患者中，41 例（93%）存在胰内胆管狭窄。在 12 例无胰头部病变的患者中，仅有 2 例存在这种狭窄（P<.0001）。腔内超声显示严重狭窄时胰内胆管壁平均增厚 2.7±1.0mm，显著厚于轻度狭窄时（1.9±0.35mm；P=.0200）。
并非所有患者均进行了腔内超声检查。
胰腺水肿和胆管壁增厚均影响 AIP 中的胰内胆管狭窄。这种类型的狭窄应与可能仅由胆管壁增厚引起的胰外胆管狭窄相区分。
