内镜逆行胰胆管造影（ERCP）下胰液细胞学检查在胰腺导管内乳头状黏液瘤（IPMN）患者中的安全性和益处。

The safety and benefit of pancreatic juice cytology under ERCP in IPMN patients.

作者信息

Yoshioka Teppei, Shigekawa Minoru, Yamai Takuo, Suda Takahiro, Kegasawa Tadashi, Iwahashi Kiyoshi, Ikezawa Kenji, Sakamori Ryotaro, Yakushijin Takayuki, Hiramatsu Naoki, Tatsumi Tomohide, Takehara Tetsuo

机构信息

Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita 565-0871, Osaka, Japan.

出版信息

Pancreatology. 2016 Nov-Dec;16(6):1020-1027. doi: 10.1016/j.pan.2016.08.009. Epub 2016 Aug 18.

DOI:10.1016/j.pan.2016.08.009

PMID:27567445

Abstract

BACKGROUND

International consensus guidelines 2012 for intraductal papillary mucinous neoplasia (IPMN), defined two characteristics: high-risk stigmata (HRS) and worrisome features (WF). Patients with WF require detailed examination including cytology. However, routine endoscopic retrograde cholangiopancreatography (ERCP) for cytology is not recommended in the guidelines due to risk of post-ERCP pancreatitis (PEP). Our aim was to clarify what types of IPMN were susceptible for PEP and gain benefit of ERCP.

PATIENTS/METHODS: We examined 138 consecutive IPMN patients who underwent ERCP in our hospital, retrospectively. Patients were classified into HRS, WF and the others (N) based on imaging findings before ERCP. We assessed pancreatic juice cytology, PEP frequency and rate of malignant IPMN at 12 months after ERCP.

RESULTS

The rates of cytological malignancy were 0% (N), 4.8% (WF) and 19.5% (HRS). The PEP frequency was 14.5%, and these risk factors were branch duct (BD)-IPMN, body/tail cysts and brush cytology by multivariate logistic analysis. The rates of malignant IPMN were 0% (N), 16.4% (WF) and 48.8% (HRS). Furthermore, we examined patients with WF in detail. The PEP frequency/rate of malignancy were 3.6%/23.1% in patients with main pancreatic duct (MPD) dilatation (5-9 mm), and the sensitivity of cytology was 33.3%. On the other hand, the PEP frequency/rate of malignancy were 17.2%/0% in patients with BD-IPMN fulfilling only cyst size over 30 mm.

CONCLUSIONS

Routine ERCP for IPMN, especially for BD-IPMN, is not recommended. ERCP may be beneficial for WF patients with MPD dilatation based on a balance between PEP risk and presence of malignancy.

摘要

背景

2012年国际导管内乳头状黏液性肿瘤（IPMN）共识指南定义了两个特征：高危征象（HRS）和可疑特征（WF）。具有WF的患者需要进行包括细胞学检查在内的详细检查。然而，由于内镜逆行胰胆管造影术（ERCP）后胰腺炎（PEP）的风险，指南中不推荐常规进行ERCP以获取细胞学检查。我们的目的是明确哪些类型的IPMN易发生PEP并从ERCP中获益。

患者/方法：我们回顾性研究了我院138例连续接受ERCP的IPMN患者。根据ERCP前的影像学表现将患者分为HRS、WF和其他组（N）。我们评估了ERCP后12个月时的胰液细胞学检查、PEP发生率和恶性IPMN的发生率。

结果

细胞学恶性率在N组为0%，WF组为4.8%，HRS组为19.5%。PEP发生率为14.5%，多因素逻辑分析显示这些危险因素为分支导管（BD）-IPMN、体/尾囊肿和刷检细胞学检查。恶性IPMN的发生率在N组为0%，WF组为16.4%，HRS组为48.8%。此外，我们对具有WF的患者进行了详细检查。主胰管（MPD）扩张（5 - 9毫米）的患者中，PEP发生率/恶性率为3.6%/23.1%，细胞学检查的敏感性为33.3%。另一方面，仅囊肿大小超过30毫米的BD-IPMN患者中，PEP发生率/恶性率为17.2%/0%。