Michailidis Lamprinos, Aslam Bilal, Grigorian Alla, Mardini Houssam
Department of Medicine, Division of Digestive Diseases and Nutrition, University of Kentucky College of Medicine, USA.
Ann Gastroenterol. 2017;30(5):550-558. doi: 10.20524/aog.2017.0159. Epub 2017 May 12.
The purpose of this study was to perform a meta-analysis assessing the efficacy and predictors of success of endoscopic therapy in the management of patients with pancreas divisum.
An electronic database search (PubMed and ScienceDirect) was performed for relevant studies. Studies were selected based on predefined criteria and data were extracted on patient population, follow up, endotherapy methods, success rates and complication rates. A random-effect model was used to pool the effect size across studies. Heterogeneity testing and publication bias assessment were performed. Multivariate regression analysis was performed to identify predictors of successful endoscopic therapy.
Of 381 articles reviewed, 23 studies with 874 patients met the inclusion criteria. All were case series with suboptimal quality. Endoscopic therapy included minor papilla sphincterotomy, minor papilla sphincteroplasty and dorsal duct stenting. Mean follow-up duration was 37 months. The rate of "improvement" as defined by authors after endoscopic therapy varied significantly across studies, ranging from 31-96%: 589/874 patients were reported to have improved, corresponding to a pooled efficacy rate of 67.5% (95% confidence interval [CI] 0.610-0.734; P=0.0001). The pooled rate of pancreatitis after endoscopic retrograde cholangiopancreatography was 10.1% (95%CI 0.084-0.124; 2-sided P=0.0001). On subgroup analysis, patients with recurrent acute pancreatitis had better endoscopic outcomes (pooled efficacy rate 76%, 95%CI 0.712-0.803, P=0.0001). Dorsal duct stenting and longer follow up were the only parameters predictive of successful endotherapy. Significant heterogeneity was observed within and across studies.
Endoscopic efficacy in pancreas divisum is estimated at 67.5%. Available studies are of poor quality with significant heterogeneity. Comparative studies with rigorous methodology are needed.
本研究旨在进行一项荟萃分析，评估内镜治疗在胰腺分裂症患者管理中的疗效及成功预测因素。
通过电子数据库检索（PubMed和ScienceDirect）相关研究。根据预定义标准选择研究，并提取患者人群、随访、内镜治疗方法、成功率和并发症发生率等数据。采用随机效应模型汇总各研究的效应量。进行异质性检验和发表偏倚评估。进行多变量回归分析以确定内镜治疗成功的预测因素。
在381篇综述文章中，23项研究共874例患者符合纳入标准。所有研究均为病例系列，质量欠佳。内镜治疗包括小乳头括约肌切开术、小乳头括约肌成形术和背侧胰管支架置入术。平均随访时间为37个月。各研究中作者定义的内镜治疗后“改善”率差异显著，范围为31%-96%：据报道，874例患者中有589例病情改善，汇总有效率为67.5%（95%置信区间[CI]0.610-0.734；P=0.0001）。内镜逆行胰胆管造影术后胰腺炎的汇总发生率为10.1%（95%CI 0.084-0.124；双侧P=0.0001）。亚组分析显示，复发性急性胰腺炎患者的内镜治疗效果更佳（汇总有效率76%，95%CI 0.712-0.803，P=0.0001）。背侧胰管支架置入术和更长的随访时间是内镜治疗成功的唯一预测参数。研究内部和研究之间均观察到显著的异质性。
胰腺分裂症的内镜治疗有效率估计为67.5%。现有研究质量较差，存在显著异质性。需要采用严格方法进行比较研究。
