Division of Endoscopy, European Institute of Oncology, IRCCS, Milan, Italy.
Eur J Gastroenterol Hepatol. 2011 May;23(5):367-74. doi: 10.1097/MEG.0b013e3283460129.
Acute biliary pancreatitis (ABP) is a clinical condition that can rapidly evolve into a life-threatening one. Endoscopic retrograde cholangiopancreatography (ERCP) has been considered the standard treatment of ABP for many years, though it entails the risk of morbidity and mortality. Endoscopic ultrasonography (EUS) can reliably diagnose choledocholithiasis avoiding unnecessary ERCP in patients with no stones in the biliary tract.
We undertook a systematic review of the randomized controlled trials and clinical trials comparing EUS and ERCP to evaluate procedure performance, complication rates, clinical course of pancreatitis, and hospital stay according to the treatment given.
A computerized bibliographic search was performed from 1994 to April 2010. Two reviewers assessed the methodological quality of eligible trials and independently extracted data from the included trials.
Seven studies enrolled 545 patients with acute pancreatitis of suspected biliary origin. Only one was a randomized controlled trial. EUS had a lower failure rate than ERCP in all the studies included, avoiding ERCP in 71.2% of cases. No complications were related to EUS, whereas sphincterotomy was associated with bleeding in up to 22% of patients. The procedures did not influence the clinical course of pancreatitis.
A strategy based on EUS before ERCP in patients with ABP may be an effective alternative to diagnostic ERCP.
急性胆源性胰腺炎（ABP）是一种可能迅速发展为危及生命的临床病症。多年来，内镜逆行胰胆管造影术（ERCP）一直被认为是 ABP 的标准治疗方法，但它存在一定的发病率和死亡率风险。内镜超声检查（EUS）可以可靠地诊断胆总管结石，避免对没有胆道结石的患者进行不必要的 ERCP。
我们进行了一项系统评价，比较了 EUS 和 ERCP 的随机对照试验和临床试验，以评估根据治疗方法，评估操作性能、并发症发生率、胰腺炎的临床病程和住院时间。
计算机文献检索从 1994 年到 2010 年 4 月进行。两名评审员评估了合格试验的方法学质量，并从纳入的试验中独立提取数据。
共有 7 项研究纳入了 545 例疑似胆源性胰腺炎的患者。只有一项是随机对照试验。在所有纳入的研究中，EUS 的失败率均低于 ERCP，可避免 71.2%的 ERCP 操作。EUS 无相关并发症，而括约肌切开术与高达 22%的患者出血有关。这些操作不影响胰腺炎的临床病程。
在 ABP 患者中，基于 EUS 的 ERCP 前策略可能是诊断性 ERCP 的有效替代方法。
