Department of Gastroenterology, Hôpital Privé Jean Mermoz, 55 avenue Jean Mermoz, 69008 Lyon, France.
Surg Endosc. 2013 Sep;27(9):3377-87. doi: 10.1007/s00464-013-2920-9. Epub 2013 Apr 3.
Pancreatitis is the most feared complication of endoscopic papillectomy (EP). Prevention by pancreatic duct stenting following EP has been advocated but not proven by a randomized trial. The purpose of the present retrospective review is to compare a period of systematic stenting with the period before in which stents were placed selectively.
A total of 107 patients undergoing EP from February 1999 to December 2009 were retrospectively reviewed. After an initial period with selective stenting (dilated duct, previous pancreatitis) between 1999 and 2002 (n = 24, group 1), stents were placed routinely after EP unless pancreas divisum was diagnosed (2002-2009; n = 83, group 2) to reduce postpapillectomy acute pancreatitis (PAP). PAP rates defined by Consensus Criteria were compared in the two periods.
Five patients in group 1 were selected to receive a pancreatic stent (21%); in group 2 stenting was successful in 75 of 78 patients (success rate 96%) without pancreas divisum (n = 5). Overall, PAP occurred in 11% of patients. PAP rate was significantly reduced after introduction of systematic pancreatic stenting (5 vs 25%; p = 0.01) and occurred less often in stented than in nonstented patients: (5% (4/80) vs 27% (6/22), p = 0.0019). PAP also occurred in one of five patients with pancreas divisum. Selective stenting of patients also was an independent risk factor for PAP (OR 13, p = 0.001) in a multivariate analysis.
Attempts at systematic stenting after EP pancreatic stenting appears to prevent PAP. Results should be corroborated by a randomized trial.
胰腺炎是内镜乳头切开术（EP）最可怕的并发症。有研究提倡在 EP 后通过胰管支架置入来预防胰腺炎，但尚未通过随机试验证实。本回顾性研究的目的是比较系统支架置入与选择性支架置入前的时期。
回顾性分析 1999 年 2 月至 2009 年 12 月期间接受 EP 的 107 例患者。在 1999 年至 2002 年选择性支架置入（扩张的胰管，既往胰腺炎）的初始阶段（n = 24，组 1）后，除非诊断为胰腺分裂（2002-2009 年；n = 83，组 2），否则 EP 后常规放置支架以降低经乳头胰管切开术后急性胰腺炎（PAP）的发生率。比较两组中用共识标准定义的 PAP 发生率。
组 1 中有 5 例患者选择接受胰管支架（21%）；组 2 中在无胰腺分裂的情况下，78 例患者中有 75 例（成功率 96%）成功置入支架（n = 5）。总的来说，11%的患者发生了 PAP。系统胰管支架置入后，PAP 发生率显著降低（5% vs 25%；p = 0.01），且支架置入患者的 PAP 发生率低于未支架置入患者：（5%（4/80） vs 27%（6/22），p = 0.0019）。胰腺分裂的 5 例患者中也有 1 例发生 PAP。多变量分析显示，选择性支架置入也是 PAP 的独立危险因素（OR 13，p = 0.001）。
EP 后尝试进行系统支架置入似乎可以预防 PAP。结果需要通过随机试验加以证实。
