Department of Gastroenterology and Foundation for Research in Digestive Diseases, University Hospital of Santiago de Compostela, Spain.
Pancreas. 2012 Jul;41(5):724-8. doi: 10.1097/MPA.0b013e31823b5978.
Functional evaluation of the pancreas is hindered by invasiveness and/or methodological difficulties. Endoscopic ultrasonography (EUS) provides with highly accurate images of pancreatic ducts and parenchyma. The aim of the study was to analyze the probability of pancreatic exocrine insufficiency (PEI) according to EUS criteria in patients with a diagnosis of chronic pancreatitis.
A total of 128 consecutive patients (mean age, 52 years; 104 men) with chronic pancreatitis were prospectively included. Pancreatic exocrine insufficiency was diagnosed by the carbon 13-mixed triglyceride breath test. Endoscopic ultrasonography was performed and EUS criteria of chronic pancreatitis evaluated by 2 different experienced endosonographers who were blinded to the results of the pancreatic function test.
Forty-eight patients (37.5%) had PEI. The percentage of patients with PEI increased linearly with the number of EUS criteria. The presence of intraductal calcifications, hyperechogenic foci with shadowing, and dilation of the main pancreatic duct were significantly and independently associated to PEI. The probability of PEI in the presence of calculi in the main pancreatic duct is 80% and increases to 82.8% if, in addition, the main duct is dilated.
Endoscopic ultrasonography findings allow predicting the probability of PEI in patients with chronic pancreatitis and thus the need for pancreatic enzyme replacement therapy.
胰腺功能评估受到侵袭性和/或方法学困难的阻碍。内镜超声检查（EUS）可提供胰腺导管和实质的高度准确图像。本研究旨在根据 EUS 标准分析诊断为慢性胰腺炎患者发生胰腺外分泌功能不全（PEI）的概率。
共前瞻性纳入 128 例连续的慢性胰腺炎患者（平均年龄 52 岁；104 例男性）。通过 13C-混合三酸甘油脂呼吸试验诊断胰腺外分泌功能不全。进行内镜超声检查，并由 2 名经验丰富的内镜超声医师进行 EUS 慢性胰腺炎标准评估，他们对胰腺功能试验的结果不知情。
48 例（37.5%）患者存在 PEI。存在 EUS 标准的数量与 PEI 患者的比例呈线性增加。存在胰管内钙化、伴声影的高回声灶和主胰管扩张与 PEI 显著且独立相关。主胰管内存在结石时，PEI 的概率为 80%，如果主胰管同时扩张，概率增加至 82.8%。
内镜超声检查结果可预测慢性胰腺炎患者发生 PEI 的概率，从而确定是否需要胰酶替代治疗。
