Service of Gastroenterology and Hepatology, Geneva University Hospitals, Rue Gabrielle Perret Gentil 4, Geneva, Switzerland.
Endoscopy. 2012 Aug;44(8):784-800. doi: 10.1055/s-0032-1309840. Epub 2012 Jul 2.
BACKGROUND AND AIMS: Clarification of the position of the European Society of Gastrointestinal Endoscopy (ESGE) regarding the interventional options available for treating patients with chronic pancreatitis. METHODS: Systematic literature search to answer explicit key questions with levels of evidence serving to determine recommendation grades. The ESGE funded development of the Guideline. SUMMARY OF SELECTED RECOMMENDATIONS: For treating painful uncomplicated chronic pancreatitis, the ESGE recommends extracorporeal shockwave lithotripsy/endoscopic retrograde cholangiopancreatography as the first-line interventional option. The clinical response should be evaluated at 6 - 8 weeks; if it appears unsatisfactory, the patient's case should be discussed again in a multidisciplinary team. Surgical options should be considered, in particular in patients with a predicted poor outcome following endoscopic therapy (Recommendation grade B). For treating chronic pancreatitis associated with radiopaque stones ≥ 5 mm that obstruct the main pancreatic duct, the ESGE recommends extracorporeal shockwave lithotripsy as a first step, combined or not with endoscopic extraction of stone fragments depending on the expertise of the center (Recommendation grade B). For treating chronic pancreatitis associated with a dominant stricture of the main pancreatic duct, the ESGE recommends inserting a single 10-Fr plastic stent, with stent exchange planned within 1 year (Recommendation grade C). In patients with ductal strictures persisting after 12 months of single plastic stenting, the ESGE recommends that available options (e. g., endoscopic placement of multiple pancreatic stents, surgery) be discussed in a multidisciplinary team (Recommendation grade D).For treating uncomplicated chronic pancreatic pseudocysts that are within endoscopic reach, the ESGE recommends endoscopic drainage as a first-line therapy (Recommendation grade A).For treating chronic pancreatitis-related biliary strictures, the choice between endoscopic and surgical therapy should rely on local expertise, patient co-morbidities and expected patient compliance with repeat endoscopic procedures (Recommendation grade D). If endoscopy is elected, the ESGE recommends temporary placement of multiple, side-by-side, plastic biliary stents (Recommendation grade A).
背景与目的:阐明欧洲胃肠道内镜学会(ESGE)在治疗慢性胰腺炎患者的干预选择方面的立场。
方法:系统文献检索以回答明确的关键问题,并提供证据级别以确定推荐等级。ESGE 为指南的制定提供了资金支持。
推荐意见摘要:对于治疗疼痛性非复杂性慢性胰腺炎,ESGE 建议体外冲击波碎石术/内镜逆行胰胆管造影术作为一线干预选择。应在 6-8 周时评估临床反应;如果反应不理想,应在多学科团队中再次讨论患者的情况。应考虑手术选择,特别是在预测内镜治疗后预后不佳的患者中(推荐等级 B)。对于治疗伴有≥5mm 不透射线结石并阻塞主胰管的慢性胰腺炎,ESGE 建议首先进行体外冲击波碎石术,根据中心的专业知识,结合或不结合内镜下结石碎片提取(推荐等级 B)。对于治疗伴有主胰管优势狭窄的慢性胰腺炎,ESGE 建议插入单个 10Fr 塑料支架,计划在 1 年内更换支架(推荐等级 C)。对于接受单支塑料支架治疗 12 个月后仍存在胰管狭窄的患者,ESGE 建议在多学科团队中讨论可用的选择(例如,内镜下放置多个胰腺支架、手术)(推荐等级 D)。对于可通过内镜到达的非复杂性慢性胰腺假性囊肿,ESGE 建议内镜引流作为一线治疗(推荐等级 A)。对于治疗与慢性胰腺炎相关的胆管狭窄,内镜治疗和手术治疗的选择应取决于当地专业知识、患者合并症和患者对重复内镜手术的依从性(推荐等级 D)。如果选择内镜治疗,ESGE 建议临时放置多个并排的塑料胆管支架(推荐等级 A)。
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