Xu Xiao-Dan, Dai Jian-Jun, Qian Jian-Qing, Wang Wei-Jun
Changshu Affiliated Hospital of Suzhou Universit, Changshu, China,
Dig Dis Sci. 2015 Apr;60(4):1087-91. doi: 10.1007/s10620-014-3400-3. Epub 2014 Oct 17.
Endoscopic papillary balloon dilation (EPBD) was associated with a higher rate of endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP).
The purpose of this study was to determine whether placement of an endoscopic nasobiliary drainage (ENBD) catheter can also prevent PEP after EPBD.
A total of 93 patients, who with proven common bile duct (CBD) stones, received EPBD were enrolled this trial. They were randomly divided into ENBD group (n = 45) and no-ENBD group (n = 48) according whether undergone an ENBD procedure after EPBD. Their demographics, laboratory, procedural data were collected, and pancreaticobiliary complications were followed.
The number of patients with serum amylase levels above the normal upper limit (>180 U/L) did not differ between groups. However, compared with ENBD group, more patients in No-ENBD group had levels greater than three times the normal limit (>540 U/L) (11/48 vs 3/45, P = 0.0285), and more patients developed to PEP (7/48 vs 0/45, P = 0.0250). During follow-up, the numbers of patients undergone cholecystectomy, cholangitis and recurrence of CBD stones were similar. There was also no significant difference in the cumulative rate of recurrent pancreaticobiliary complications between the two groups (P = 0.452).
EPBD followed by insertion of an ENBD catheter can prevent PEP, and routine ENBD catheter placement is recommended after an EPBD procedure.
内镜下乳头球囊扩张术（EPBD）与较高的内镜逆行胰胆管造影术（ERCP）后胰腺炎（PEP）发生率相关。
本研究旨在确定放置内镜鼻胆管引流（ENBD）导管是否也能预防EPBD术后的PEP。
本试验纳入了93例经证实患有胆总管（CBD）结石并接受EPBD的患者。根据EPBD术后是否进行ENBD操作，将他们随机分为ENBD组（n = 45）和非ENBD组（n = 48）。收集他们的人口统计学、实验室和操作数据，并跟踪胰胆并发症。
血清淀粉酶水平高于正常上限（>180 U/L）的患者数量在两组之间没有差异。然而，与ENBD组相比，非ENBD组中血清淀粉酶水平大于正常上限三倍（>540 U/L）的患者更多（11/48 vs 3/45，P = 0.0285），发生PEP的患者也更多（7/48 vs 0/45，P = 0.0250）。在随访期间，接受胆囊切除术、胆管炎和CBD结石复发的患者数量相似。两组之间复发性胰胆并发症的累积发生率也没有显著差异（P = 0.452）。
EPBD后插入ENBD导管可预防PEP，建议在EPBD术后常规放置ENBD导管。
