Mouri Teruo, Sasaki Tamito, Serikawa Masahiro, Ishigaki Takashi, Ishii Yasutaka, Shimizu Akinori, Tsuboi Tomofumi, Kurihara Keisuke, Tatsukawa Yumiko, Miyaki Eisuke, Kawamura Ryota, Tsushima Ken, Chayama Kazuaki
Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan.
J Gastroenterol Hepatol. 2016 Oct;31(10):1783-1789. doi: 10.1111/jgh.13314.
Although endoscopic nasopancreatic drainage (ENPD) is useful for collecting samples for pancreatic juice cytology and for treating leakage of pancreatic juice and occlusive pancreatitis, placement of the ENPD catheter is associated with complications such as post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). We investigated whether an ENPD catheter with a smaller diameter could reduce the incidence of complications.
Patients requiring placement of an ENPD catheter (n = 254) were enrolled and randomly assigned to one of two catheter-size groups: the 4-Fr group or the 5-Fr group. The incidence of PEP, cholangitis, and spontaneous catheter displacement and the suitability of pancreatic juice cytology samples were compared between groups. In addition, univariate and multivariate analyses were conducted on factors associated with PEP.
The incidence of PEP was significantly lower in the 4-Fr group compared with the 5-Fr group (4.1% vs 12.4%, respectively; P = 0.021). The rate of cholangitis and spontaneous catheter displacement and the suitability of pancreatic juice cytology samples did not differ between groups. Multivariate analysis revealed that the risk of PEP was 3.7 times higher when using a 5-Fr catheter than when using a 4-Fr catheter (P = 0.019). In addition, the risk of PEP was 4.1 times higher in patients with an intraductal papillary mucinous neoplasm than in those without (P = 0.0049) and 4.6 times higher in patients aged <65 than in those aged ≥65 (P = 0.0033).
A 4-Fr catheter is as useful as a 5-Fr catheter and is associated with a significantly lower incidence of PEP.
尽管内镜下鼻胰管引流术（ENPD）对于采集胰液细胞学样本以及治疗胰液漏和闭塞性胰腺炎很有用，但ENPD导管的放置与诸如内镜逆行胰胆管造影术后胰腺炎（PEP）等并发症相关。我们研究了直径较小的ENPD导管是否能降低并发症的发生率。
纳入需要放置ENPD导管的患者（n = 254），并将其随机分配到两个导管尺寸组之一：4F组或5F组。比较两组之间PEP、胆管炎和导管自发移位的发生率以及胰液细胞学样本的适宜性。此外，对与PEP相关的因素进行单因素和多因素分析。
4F组的PEP发生率显著低于5F组（分别为4.1%和12.4%；P = 0.021）。两组之间胆管炎和导管自发移位的发生率以及胰液细胞学样本的适宜性没有差异。多因素分析显示，使用5F导管时PEP的风险比使用4F导管时高3.7倍（P = 0.019）。此外，导管内乳头状黏液性肿瘤患者发生PEP的风险比无该肿瘤的患者高4.1倍（P = 0.0049），年龄<65岁的患者发生PEP的风险比年龄≥65岁的患者高4.6倍（P = 0.0033）。
4F导管与5F导管一样有用，且与显著更低的PEP发生率相关。
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