Division of Gastroenterology-Hepatology, University of Alabama at Birmingham School of medicine, Birmingham, Alabama 35294-0007, USA.
J Gastroenterol Hepatol. 2010 Mar;25(3):526-31. doi: 10.1111/j.1440-1746.2009.06109.x. Epub 2010 Jan 13.
The role of pancreatic duct (PD) stenting in patients undergoing endoscopic transmural drainage of peripancreatic fluid collection (PFC) remains unclear. The objective of this study is to evaluate the effect of PD stenting on treatment success in patients undergoing endoscopic transmural drainage of PFC.
This is a retrospective follow-up study of all patients who underwent endoscopic and endoscopic ultrasonography-guided transmural drainage of PFC during a 5-year period. Double-pigtail stents were deployed in all patients; in addition, nasocystic catheters were deployed in those with abscess/necrosis. An endoscopic retrograde cholangiopancreatogram was attempted whenever feasible in all patients, and pancreatic stents were placed when the duct disruption could be bridged. Success was defined as an improvement in symptoms and resolution of PFC upon follow-up computed tomography at 8 weeks.
Of the 110 patients who underwent PFC drainage, 40 (36%) underwent simultaneous PD stenting. Treatment was successful in 95 of the 110 patients (86%). The PFC types were: pseudocyst (62%), necrosis (20%), and abscess (18%). The median duration of follow up was 9.9 months. Those who underwent PD stenting were significantly more likely to have treatment success than those who did not undergo PD stenting (97.5% vs 80%; risk ratio RR = 1.48, P = 0.01). In the multivariable analysis, this association remained significant (RR(adjusted) = 1.14, 95% confidence interval: 1.01-1.29, P = 0.036), even after adjusting for the etiology of pancreatitis, type and location of PFC, luminal compression at endoscopy, enteral nutrition, white blood cell count, and number of endoscopic interventions.
Transpapillary PD stenting improves treatment outcomes in patients undergoing endoscopic transmural drainage of PFC.
在接受内镜经壁引流胰周积液（PFC）的患者中，胰管（PD）支架的作用尚不清楚。本研究旨在评估 PD 支架置入对内镜经壁引流 PFC 患者治疗成功的影响。
这是一项对 5 年内所有接受内镜和内镜超声引导经壁引流 PFC 的患者进行的回顾性随访研究。所有患者均放置双猪尾支架；对于脓肿/坏死患者，还放置鼻囊管。所有患者均尝试行内镜逆行胰胆管造影术，当能够桥接胰管破裂时放置胰管支架。成功定义为在 8 周的随访计算机断层扫描时症状改善和 PFC 消退。
在 110 例行 PFC 引流的患者中，40 例（36%）同时行 PD 支架置入。110 例患者中，95 例（86%）治疗成功。PFC 类型为：假性囊肿（62%）、坏死（20%）和脓肿（18%）。中位随访时间为 9.9 个月。与未行 PD 支架置入的患者相比，行 PD 支架置入的患者更有可能获得治疗成功（97.5%比 80%；粗风险比[RR]（crude）=1.48，P=0.01）。多变量分析显示，即使在调整胰腺炎病因、PFC 类型和位置、内镜下管腔压迫、肠内营养、白细胞计数和内镜干预次数后，这种关联仍然具有统计学意义（RR（调整）=1.14，95%置信区间：1.01-1.29，P=0.036）。
经乳头 PD 支架置入可改善内镜经壁引流 PFC 患者的治疗结局。
