Division of Gastroenterology, Department of Internal Medicine, Kwandong University College of Medicine, Myongji Hospital, Goyang, Republic of Korea.
Pancreatology. 2012 Nov-Dec;12(6):495-501. doi: 10.1016/j.pan.2012.08.007. Epub 2012 Sep 10.
BACKGROUND/OBJECTIVES: Endoscopic ultrasonography (EUS) is an accurate imaging modality for delineating pancreatobiliary structures, however, its clinical application of acute pancreatitis (AP) is limited. Therefore, we sought to characterize the typical EUS features of AP and to determine whether early EUS findings may have prognostic significance.
Between March 2008 and October 2010, 90 patients with AP and 90 patients without pancreatic disease who underwent EUS were enrolled. An EUS examination was performed within 48 h of admission in AP, and all EUS findings were retrospectively analyzed.
Among 90 patients, 27 (30%) were diagnosed with severe AP. Multivariate analysis revealed the presence of peripancreatic fluid (OR 13.9, 95%, CI: 1.6-123.6), heterogenous (OR 7.2, 95% CI: 1.7-30.4) and hypoechoic parenchymal echogenicity (OR 10.0, 95% CI: 3.9-25.8) were significant EUS features in AP, as compared to those in the control group. Comparison between mild and severe AP showed that geographic hyperechoic area (GHA) of pancreas was a predictive factor (OR 2.9, 95% CI: 1.1-8.2, p = 0.04) for the severe form, and that AP patients with GHA had significantly longer duration of fever, abdominal pain and hospital stay than those without GHA (5.5 vs. 1 day (s), p = 0.002; 4 vs. 3 days, p = 0.023; 11 vs. 8 days, p = 0.021, respectively).
Typical EUS features of AP are a heterogenous hypoechoic parenchymal changes with peripancreatic fluid collection. The novel EUS variable of GHA in the early phase of AP seems to have prognostic value and could be correlated with a worse clinical outcome.
背景/目的：内镜超声检查（EUS）是一种准确的成像方式，可用于描绘胰胆管结构，但在急性胰腺炎（AP）的临床应用中受到限制。因此，我们试图描述 AP 的典型 EUS 特征，并确定早期 EUS 结果是否具有预后意义。
在 2008 年 3 月至 2010 年 10 月期间，纳入 90 例 AP 患者和 90 例无胰腺疾病的患者，这些患者均接受了 EUS 检查。在 AP 入院后 48 小时内进行 EUS 检查，对所有 EUS 结果进行回顾性分析。
在 90 例患者中，27 例（30%）被诊断为重症 AP。多变量分析显示，胰周积液（OR 13.9，95%CI：1.6-123.6）、不均匀回声（OR 7.2，95%CI：1.7-30.4）和低回声胰腺实质回声（OR 10.0，95%CI：3.9-25.8）是 AP 与对照组相比的显著 EUS 特征。轻症和重症 AP 比较显示，胰腺局灶性高回声区（GHA）是重症 AP 的预测因素（OR 2.9，95%CI：1.1-8.2，p = 0.04），GHA 的 AP 患者发热、腹痛和住院时间明显长于无 GHA 的患者（5.5 天 vs. 1 天（s），p = 0.002；4 天 vs. 3 天，p = 0.023；11 天 vs. 8 天，p = 0.021）。
AP 的典型 EUS 特征是伴有胰周积液的不均匀低回声胰腺实质变化。AP 早期的新型 EUS 变量 GHA 似乎具有预后价值，并可能与更差的临床结局相关。
