Departments of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China.
Pancreas. 2010 Apr;39(3):398-402. doi: 10.1097/MPA.0b013e3181bd6821.
The effect of early endoscopic intervention (EI; within 72 hours) remains a controversial subject. This prospective study was aimed to evaluate the efficacy of early EI without fluoroscopy on severe acute biliary pancreatitis (SABP) in the intensive care unit (ICU).
Fifty-three patients with SABP + ampullary obstruction in the ICU were divided randomly into 2 groups: conservative treatment in the ICU (CTI arm) and CTI + EI without the aid of fluoroscopy (CTI + EI arm). Decreased Acute Physiology and Chronic Health Evaluation II score was the major parameter to assess treatment efficacy.
Endoscopic treatments including sphincterotomy + stone removal (17 cases) and nasobiliary drainage (4 cases) were successfully performed in all 21 enrolled patients without the aid of fluoroscopy in the ICU. Compared with CTI, CTI + EI significantly resulted in decreased (3.86 +/- 2.08 vs 6.57 +/- 1.54) Acute Physiology and Chronic Health Evaluation II score at day 10, P < 0.05. No deaths were observed in the CTI + EI, whereas the CTI arm had 2 mortalities.
Urgent EI without fluoroscopy is possible to be performed by endoscopists with the experience from high volume of procedures and is beneficial for the patients with SABP in the ICU or community hospital.
早期内镜干预（EI；72 小时内）的效果仍然存在争议。本前瞻性研究旨在评估在重症监护病房（ICU）中不使用透视的早期 EI 对重症急性胆源性胰腺炎（SABP）的疗效。
53 例 ICU 中伴有壶腹梗阻的 SABP 患者被随机分为 2 组：ICU 中的保守治疗（CTI 组）和 CTI+不使用透视的 EI（CTI+EI 组）。急性生理学和慢性健康评估 II 评分降低是评估治疗效果的主要参数。
在 ICU 中，所有 21 名纳入患者均成功进行了内镜治疗，包括括约肌切开术+取石（17 例）和鼻胆管引流（4 例），无需透视。与 CTI 相比，CTI+EI 在第 10 天的急性生理学和慢性健康评估 II 评分显著降低（3.86+/-2.08 比 6.57+/-1.54），P<0.05。CTI+EI 组无死亡病例，而 CTI 组有 2 例死亡。
经验丰富的内镜医生可以在 ICU 或社区医院中进行无需透视的紧急 EI，这对 SABP 患者有益。
