Department of Gastroenterology and Hepatology, Kindai University, Osaka-sayama, Japan.
Clinical Research Center, Kindai University Hospital, Osaka-sayama, Japan.
Dig Endosc. 2018 Sep;30(5):659-666. doi: 10.1111/den.13176. Epub 2018 May 16.
This study evaluated the utility of endoscopic ultrasonography (EUS) combined with contrast-enhanced harmonic EUS (CH-EUS) for surveillance of the remnant pancreas after surgery for intraductal papillary mucinous neoplasm (IPMN).
This was a single-center, retrospective, descriptive study. A total of 134 consecutive patients who underwent surgical resection for IPMN between April 2009 and March 2015 were evaluated. Rates of recurrence and development of IPMN-concomitant pancreatic ductal adenocarcinoma (PDAC) during follow up were assessed. Clinical findings of patients with recurrence or development of PDAC were also evaluated.
Of 134 resected IPMN 56 (41.8%) and 78 (58.2%) were classified as benign and malignant, respectively. Patients were followed up for a median of 29 months, 33 (24.6%) by both contrast-enhanced computed tomography (CE-CT) and EUS, and 101 (75.4%) by computed tomography (CT) alone. Thirteen patients (9.7%) showed tumor recurrence, five with intra-pancreatic recurrence and eight with extra-pancreatic metastases. An enhancing mural nodule within the dilated main pancreatic duct was successfully detected by EUS in one patient, but not by CE-CT. Two patients developed IPMN-concomitant PDAC during follow up. EUS combined with CH-EUS successfully detected small IPMN-concomitant PDAC in two patients, whereas these lesions were not detected by CT. CH-EUS was useful for better visualization of the margins of IPMN-concomitant PDAC in one of these two patients.
Endoscopic ultrasonography combined with CH-EUS may improve follow up of patients with resected IPMN.
本研究评估了内镜超声（EUS）联合对比增强谐波超声（CH-EUS）在监测胰腺导管内乳头状黏液性肿瘤（IPMN）手术后残留胰腺中的作用。
这是一项单中心、回顾性、描述性研究。共评估了 2009 年 4 月至 2015 年 3 月期间因 IPMN 接受手术切除的 134 例连续患者。评估了随访期间的复发率和 IPMN 伴发胰腺导管腺癌（PDAC）的发生情况。还评估了复发或发生 PDAC 患者的临床发现。
在切除的 134 例 IPMN 中，56 例（41.8%）和 78 例（58.2%）分别为良性和恶性。患者中位随访时间为 29 个月，33 例（24.6%）通过增强 CT（CE-CT）和 EUS 进行随访，101 例（75.4%）仅通过 CT 进行随访。13 例（9.7%）患者出现肿瘤复发，其中 5 例为胰内复发，8 例为胰外转移。EUS 成功检测到 1 例患者扩张主胰管内的强化壁结节，但 CE-CT 未检测到。2 例患者在随访期间发生 IPMN 伴发 PDAC。EUS 联合 CH-EUS 成功检测到 2 例患者的小 IPMN 伴发 PDAC，而 CT 未检测到这些病变。CH-EUS 有助于更好地显示其中 1 例患者的 IPMN 伴发 PDAC 边缘。
EUS 联合 CH-EUS 可能改善切除 IPMN 患者的随访。
