急性复发性胰腺炎患者胰腺分裂症的内镜治疗结果
Outcome of endotherapy for pancreas divisum in patients with acute recurrent pancreatitis.
作者信息
Mariani Alberto, Di Leo Milena, Petrone Maria Chiara, Arcidiacono Paolo Giorgio, Giussani Antonella, Zuppardo Raffaella Alessia, Cavestro Giulia Martina, Testoni Pier Alberto
机构信息
Alberto Mariani, Milena Di Leo, Maria Chiara Petrone, Paolo Giorgio Arcidiacono, Antonella Giussani, Raffaella Alessia Zuppardo, Giulia Martina Cavestro, Pier Alberto Teston, Gastroenterology and Gastrointestinal Endoscopy Unit, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute - Vita Salute San Raffaele University, 20132 Milan, Italy.
出版信息
World J Gastroenterol. 2014 Dec 14;20(46):17468-75. doi: 10.3748/wjg.v20.i46.17468.
AIM
To assess the rate of relapses of acute pancreatitis (AP), recurrent AP (RAP) and the evolution of endosonographic signs of chronic pancreatitis (CP) in patients with pancreas divisum (PDiv) and RAP.
METHODS
Over a five-year period, patients with PDiv and RAP prospectively enrolled were divided into two groups: (1) those with relapses of AP in the year before enrollment were assigned to have endoscopic therapy (recent RAP group); and (2) those free of recurrences were conservatively managed, unless they relapsed during follow-up (previous RAP group). All patients in both groups entered a follow-up protocol that included clinical and biochemical evaluation, pancreatic endoscopic ultrasonography (EUS) every year and after every recurrence of AP, at the same time as endoscopic retrograde cholangiopancreatography (ERCP).
RESULTS
Twenty-two were treated by ERCP and 14 were conservatively managed during a mean follow-up of 4.5 ± 1.2 years. In the recent RAP group in whom dorsal duct drainage was achieved, AP still recurred in 11 (57.9%) after the first ERCP, in 6 after the second ERCP (31.6%) and in 5 after the third ERCP (26.3%). Overall, endotherapy was successful 73.7%. There were no cases of recurrences in the previous RAP group. EUS signs of CP developed in 57.9% of treated and 64.3% of untreated patients. EUS signs of CP occurred in 42.8% of patients whose ERCPs were successful and in all those in whom it was unsuccessful (P = 0.04). There were no significant differences in the rate of AP recurrences after endotherapy and in the prevalence of EUS signs suggesting CP when comparing patients with dilated and non-dilated dorsal pancreatic ducts within each group.
CONCLUSION
Patients with PDiv and recent episodes of AP can benefit from endoscopic therapy. Effective endotherapy may reduce the risk of developing EUS signs of CP at a rate similar to that seen in patients of previous RAP group, managed conservatively. However, in a subset of patients, endotherapy, although successful, did not prevent the evolution of endosonographic signs of CP.
目的
评估胰腺分裂症（PDiv）合并复发性急性胰腺炎（RAP）患者的急性胰腺炎（AP）复发率、复发性急性胰腺炎（RAP）情况以及慢性胰腺炎（CP）内镜超声征象的演变。
方法
在五年期间，前瞻性纳入的PDiv合并RAP患者被分为两组：（1）入组前一年有AP复发的患者接受内镜治疗（近期RAP组）；（2）无复发的患者进行保守治疗，除非在随访期间复发（既往RAP组）。两组所有患者均进入随访方案，包括临床和生化评估、每年以及每次AP复发后进行胰腺内镜超声检查（EUS），同时进行内镜逆行胰胆管造影（ERCP）。
结果
在平均4.5±1.2年的随访期间，22例接受了ERCP治疗，14例进行了保守治疗。在近期RAP组中，实现背侧导管引流后，首次ERCP后仍有11例（57.9%）发生AP复发，第二次ERCP后6例（31.6%）复发，第三次ERCP后5例（26.3%）复发。总体而言，内镜治疗成功率为73.7%。既往RAP组无复发病例。治疗患者中57.9%出现CP的EUS征象，未治疗患者中64.3%出现该征象。ERCP成功的患者中42.8%出现CP的EUS征象，ERCP不成功的患者中所有患者均出现该征象（P = 0.04）。在每组中比较扩张和未扩张的胰腺背侧导管患者时，内镜治疗后AP复发率以及提示CP的EUS征象患病率无显著差异。
结论
PDiv合并近期AP发作的患者可从内镜治疗中获益。有效的内镜治疗可能以与既往RAP组保守治疗患者相似的速率降低出现CP的EUS征象的风险。然而，在一部分患者中，内镜治疗虽然成功，但并未阻止CP内镜超声征象的演变。
Zotero 插件