壶腹周围憩室与胆胰疾病之间是否存在关联？EUS 对此问题的解答。

Is there a link between periampullary diverticula and biliopancreatic disease? An EUS approach to answer the question.

机构信息

Department of General and Specialist Medicine, Gastroenterologia-U, Città della Salute e della Scienza di Torino, Turin, Italy.

Department of Medical Sciences, Division of Gastroenterology, University of Torino, Torino, Italy.

出版信息

Dig Liver Dis. 2018 Sep;50(9):925-930. doi: 10.1016/j.dld.2018.07.034. Epub 2018 Aug 4.

DOI:10.1016/j.dld.2018.07.034

PMID:30145052

Abstract

BACKGROUND

Many studies, almost all in an Endoscopic Retrograde Cholangiopancreatography (ERCP) setting, have been conducted to establish if a link exists between periampullary diverticula (PADs) and biliopancreatic diseases but the issue is still debated.

AIMS

The objective was to clarify the link between PADs and biliopancreatic disease, for the first time using Endoscopic Ultrasound (EUS).

METHODS

We retrospectively reviewed our database seeking patients scheduled for EUS with an indication that entailed the exploration of the second duodenum. For each patient with a PAD enrolled in the study, 6 controls were randomly selected.

RESULTS

2475 patients met the inclusion criteria. Among them, 185 subjects with a PAD were found (prevalence 7.5%), 1110 subjects served as controls. Patients with a PAD had more frequently a history of cholangitis (8.1 vs 2.2%; OR 3.99, p < 0.001), a higher prevalence of common bile duct (CBD) dilation (44.3 vs 28.2%; OR 2, p < 0.0001) and a higher prevalence of CBD stones (34.1 vs 19.6%; OR 2.1, p < 0.0001). No differences were found about history of jaundice, acute/recurrent pancreatitis or EUS signs of chronic pancreatitis.

CONCLUSION

Whereas PADs were linked with history of cholangitis, CBD stones and dilation, no association was found with pancreatic diseases.

摘要

背景

许多研究——几乎都是在经内镜逆行胰胆管造影术（ERCP）环境下进行的——已经证实了壶腹周围憩室（PAD）与胆胰疾病之间存在关联，但该问题仍存在争议。

目的

本研究旨在首次使用内镜超声（EUS）明确 PAD 与胆胰疾病之间的关联。

方法

我们回顾性地审查了我们的数据库，寻找因需要探查十二指肠第二部分而接受 EUS 检查的患者。对于纳入研究的每例 PAD 患者，随机选择 6 例对照。

结果

2475 例患者符合纳入标准。其中，发现 185 例 PAD 患者（患病率为 7.5%），1110 例患者作为对照。有 PAD 的患者更常患有胆管炎病史（8.1%比 2.2%；OR 3.99，p<0.001）、胆总管（CBD）扩张更为常见（44.3%比 28.2%；OR 2，p<0.0001），CBD 结石的患病率更高（34.1%比 19.6%；OR 2.1，p<0.0001）。在黄疸、急性/复发性胰腺炎或 EUS 慢性胰腺炎征象方面，两组间无差异。