Anderloni Andrea, Galeazzi Marianna, Ballarè Marco, Pagliarulo Michela, Orsello Marco, Del Piano Mario, Repici Alessandro
Andrea Anderloni, Alessandro Repici, Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano, 20089 Milan, Italy.
World J Gastroenterol. 2015 Sep 28;21(36):10427-34. doi: 10.3748/wjg.v21.i36.10427.
To investigate the clinical usefulness of early endoscopic ultrasonography (EUS) in the management of acute biliary pancreatitis (ABP).
All consecutive patients entering the emergency department between January 2010 and December 2012 due to acute abdominal pain and showing biochemical and/or radiological findings consistent with possible ABP were prospectively enrolled. Patients were classified as having a low, moderate, or high probability of common bile duct (CBD) stones, according to the established risk stratification. Exclusion criteria were: gastrectomy or patient in whom the cause of biliary obstruction was already identified by ultrasonography. All enrolled patients underwent EUS within 48 h of their admission. Endoscopic retrograde cholangiopancreatography was performed immediately after EUS only in those cases with proven CBD stones or sludge. The following parameters were investigated: (1) clinical: age, sex, fever; (2) radiological: dilated CBD; and (3) biochemical: bilirubin, AST, ALT, gGT, ALP, amylase, lipasis, PCR. Association between presence of CBD stone at EUS and the individual predictors were assessed by univariate logistic regression. Predictors significantly associated with CBD stones (P < 0.05) were entered in a multivariate logistic regression model.
A total of 181 patients with pancreatitis were admitted to the emergency department between January 2010 and December 2012. After exclusion criteria a total of 71 patients (38 females, 53.5%, mean age 58 ± 20.12 years, range 27-89 years; 33 males, 46.5%, mean age 65 ± 11.86 years, range 41-91 years) were included in the present study. The probability of CBD stones was considered low in 21 cases (29%), moderate in 26 (37%), and high in the remaining 24 (34%). The 71 patients included in the study underwent EUS, which allowed for a complete evaluation of the target sites in all the cases. The procedure was completed in a mean time of 14.7 min (range 9-34 min), without any notable complications.The overall CBD stone frequency was 44% (31 of 71), with a significant increase from the group at low pretest probability to that at moderate (OR = 5.79, P = 0.01) and high (OR = 4.25, P = 0.03) pretest probability.
Early EUS in ABP allows, if appropriate, immediate endoscopic treatment and significant spare of unnecessary operative procedures thus reducing possible related complications.
探讨早期内镜超声检查（EUS）在急性胆源性胰腺炎（ABP）治疗中的临床应用价值。
前瞻性纳入2010年1月至2012年12月期间因急性腹痛进入急诊科且生化和/或放射学检查结果符合可能的ABP的所有连续患者。根据既定的风险分层，将患者分为胆总管（CBD）结石可能性低、中或高的类别。排除标准为：胃切除术或超声已确定胆道梗阻原因的患者。所有纳入的患者在入院后48小时内接受EUS检查。仅在证实有CBD结石或胆泥的病例中，EUS检查后立即进行内镜逆行胰胆管造影。研究了以下参数：（1）临床参数：年龄、性别、发热；（2）放射学参数：CBD扩张；（3）生化参数：胆红素、AST、ALT、γ-GT、ALP、淀粉酶、脂肪酶、PCR。通过单因素逻辑回归评估EUS检查时CBD结石的存在与各预测因素之间的关联。将与CBD结石显著相关（P<0.05）的预测因素纳入多因素逻辑回归模型。
2010年1月至2012年12月期间，共有181例胰腺炎患者入住急诊科。根据排除标准，本研究共纳入71例患者（女性38例，占53.5%，平均年龄58±20.12岁，范围27-89岁；男性33例，占46.5%）。平均年龄65±11.86岁，范围41-91岁）。21例（29%）患者的CBD结石可能性被认为低，26例（37%）为中度，其余24例（34%）为高。纳入研究的71例患者接受了EUS检查，所有病例均能对目标部位进行全面评估。该操作平均耗时14.7分钟（范围9-34分钟），无任何明显并发症。CBD结石的总体发生率为44%（71例中的31例），从预测试概率低的组到中度（OR=5.79，P=0.01）和高度（OR=4.25，P=0.03）预测试概率的组显著增加。
ABP患者早期进行EUS检查，若合适，可立即进行内镜治疗，显著避免不必要的手术操作，从而减少可能的相关并发症。
