Kwon Richard S, Young Benjamin E, Marsteller William F, Lawrence Christopher, Wu Bechien U, Lee Linda S, Mullady Daniel, Klibansky David A, Gardner Timothy B, Simeone Diane M
From the *Division of Gastroenterology, University of Michigan, Ann Arbor, MI; †Associates in Gastroenterology, Alexandria, VA; ‡Charleston Gastroenterology Specialists and §Summerville GI and Advanced Endoscopy, Charleston, SC; ‖Department of Gastroenterology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA; ¶Division of Gastroenterology, Brigham and Women's Hospital, Boston, MA; #Division of Gastroenterology, Washington University, St. Louis, MO; **Division of Gastroenterology, Maine Medical Center, Portland, ME; ††Division of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH; and ‡‡Department of Surgery, University of Michigan, Ann Arbor, MI.
Pancreas. 2016 Sep;45(8):1126-30. doi: 10.1097/MPA.0000000000000623.
This study aimed to determine if the improved pain response to endoscopic retrograde cholangiopancreatogrphy (ERCP) and pancreatic stent placement (EPS) predicts pain response in patients with chronic pancreatitis after modified lateral pancreaticojejunostomy (LPJ).
A multi-institutional, retrospective review of patients who underwent successful EPS before LPJ between 2001 and 2010 was performed. The primary outcome was narcotic independence (NI) within 2 months after ERCP or LPJ.
A total of 31 narcotic-dependent patients with chronic pancreatitis underwent successful EPS before LPJ. Ten (32%) achieved post-LPJ NI (median follow-up, 8.5 months; interquartile range [IQR], 2-38 months). Eight (80%) of 10 patients with NI post-ERCP achieved NI post-LPJ. Two (10%) without NI post-ERCP achieved NI post-LPJ. Narcotic independence post-EPS was associated strongly with NI post-LPJ with an odds ratio of 38 (P = 0.0025) and predicted post-LPJ NI with a sensitivity, specificity, positive predictive value, and negative predictive value of 80%, 90.5%, 80%, and 90.5%, respectively.
Narcotic independence after EPS is associated with NI after LPJ. Failure to achieve NI post-ERCP predicts failure to achieve NI post-LPJ. These results support the need for larger studies to confirm the predictive value of pancreatic duct stenting for better selection of chronic pancreatitis patients who will benefit from LPJ.
本研究旨在确定内镜逆行胰胆管造影术（ERCP）及胰管支架置入术（EPS）后疼痛反应改善是否可预测慢性胰腺炎患者在改良侧侧胰管空肠吻合术（LPJ）后的疼痛反应。
对2001年至2010年间在LPJ术前成功接受EPS的患者进行多机构回顾性研究。主要结局指标为ERCP或LPJ术后2个月内实现停用麻醉药品（NI）。
共有31例慢性胰腺炎麻醉药品依赖患者在LPJ术前成功接受EPS。10例（32%）患者在LPJ术后实现NI（中位随访时间8.5个月；四分位数间距[IQR]，2 - 38个月）。ERCP术后实现NI的10例患者中有8例（80%）在LPJ术后实现NI。ERCP术后未实现NI的2例患者（10%）在LPJ术后实现NI。EPS术后停用麻醉药品与LPJ术后NI密切相关，比值比为38（P = 0.0025），预测LPJ术后NI的敏感度、特异度、阳性预测值和阴性预测值分别为80%、90.5%、80%和90.5%。
EPS术后停用麻醉药品与LPJ术后NI相关。ERCP术后未实现NI可预测LPJ术后无法实现NI。这些结果支持开展更大规模研究以证实胰管支架置入术对更好地选择将从LPJ中获益的慢性胰腺炎患者的预测价值。
