Department of Gastroenterology, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
Can J Gastroenterol Hepatol. 2018 Jun 3;2018:8216109. doi: 10.1155/2018/8216109. eCollection 2018.
Recurrent pancreatitis associated with pancreatic strictures requires treatment with endoscopic retrograde pancreatography (ERP), but it is sometimes technically unsuccessful. Endoscopic ultrasound-guided pancreatic drainage (EUS-PD) was developed as an alternative to a surgical approach after failed ERP; however, the indications for EUS-PD are unclear. In this study, we evaluated the outcomes of EUS-PD and established the indications for EUS-PD.
A total of 15 patients had indications for EUS-PD for recurrent pancreatitis due to pancreatic strictures. There were eight patients with benign pancreatic strictures and seven with malignant pancreatic strictures. The success rate, adverse events, and long-term outcomes were evaluated.
The technical success rates of benign and malignant strictures were 75% (6/8) and 100% (7/7), respectively, and clinical success was achieved in 100% (6/6) and 87.5% of cases (6/7), respectively. Rendezvous procedures were performed in two patients with benign strictures. The adverse event (AE) rate was 26.7% (4/15) and included cases of peritonitis, bleeding, and stent migration. Reinterventions were performed in three patients with benign strictures and two with malignant strictures.
EUS-PD was an appropriate treatment for not only benign strictures but also malignant strictures with recurrent pancreatitis after failed ERP. However, the AE rate was high, and reinterventions were required in some cases during long-term follow-up. The indications for EUS-PD should be considered carefully, and careful follow-up is needed.
与胰管狭窄相关的复发性胰腺炎需要经内镜逆行胰胆管造影（ERP）治疗，但有时技术上不成功。内镜超声引导下的胰腺引流术（EUS-PD）是 ERP 失败后的一种替代手术方法；然而，EUS-PD 的适应证并不明确。本研究评估了 EUS-PD 的结果，并确定了 EUS-PD 的适应证。
共有 15 例因胰管狭窄导致复发性胰腺炎的患者有 EUS-PD 的适应证。其中良性胰管狭窄 8 例，恶性胰管狭窄 7 例。评估了成功率、不良事件和长期结果。
良性和恶性狭窄的技术成功率分别为 75%（6/8）和 100%（7/7），临床成功率分别为 100%（6/6）和 87.5%（6/7）。2 例良性狭窄患者行会师术。不良事件（AE）发生率为 26.7%（4/15），包括腹膜炎、出血和支架移位。3 例良性狭窄和 2 例恶性狭窄患者进行了再次介入治疗。
EUS-PD 不仅适用于良性狭窄，也适用于 ERP 失败后复发性胰腺炎的恶性狭窄。然而，AE 发生率较高，在长期随访中一些病例需要再次介入治疗。EUS-PD 的适应证应慎重考虑，并需要密切随访。
