Kim Sung Bum, Nam Yoon Jeong, Kim Kook Hyun, Kim Tae Nyeun
Department of Internal Medicine, Division of Gastroenterology and Hepatology, Yeungnam University College of Medicine, Daegu, Republic of Korea.
Eur J Gastroenterol Hepatol. 2019 Feb;31(2):192-196. doi: 10.1097/MEG.0000000000001329.
Acute gallstone pancreatitis occurs when a gallstone is impacted at the ampulla of Vater. The role of endoscopic retrograde cholangiopancreatography in the treatment of small choledocholithiasis in these patients is uncertain. The aim of this study was to compare outcomes of expectant management with endoscopic sphincterotomy for the treatment of small choledocholithiasis (≤5 mm) in patients with acute gallstone pancreatitis.
Of the 258 patients admitted for acute gallstone pancreatitis from January 2010 to December 2014, 174 patients with small choledocholithiasis were reviewed retrospectively. Patients with coexisting acute cholangitis and/or pancreatobiliary malignancy were excluded. They were divided into an endoscopic sphincterotomy group (n=64) and an expectant management group (n=110). Severity index and outcomes of pancreatitis, complications, and overall mortality were compared.
Age and sex were not significantly different between the two groups. The mean Ranson, acute physiology and chronic health evaluation-II, and bedside index of severity in acute pancreatitis scores were not significantly different between the two groups. The computed tomography severity index score was significantly higher in the expectant management group than in the endoscopic sphincterotomy group (1.6±1.1 vs. 1.0±0.9, P<0.001). Duration of hospitalization, time for normalization of the white blood cell count, and time for oral feeding were similar in both groups. There was no significant difference between two groups in the incidence of development of pseudocyst or walled-off necrosis. In addition, no difference was observed in the rate of recurrence of acute pancreatitis and readmission because of recurrent choledocholithiasis.
Expectant management seems to be effective for the treatment of patients with acute gallstone pancreatitis and size of bile duct stones equal to or less than 5 mm.
当胆结石嵌顿于 Vater 壶腹时会发生急性胆石性胰腺炎。内镜逆行胰胆管造影术在这些患者小胆总管结石治疗中的作用尚不确定。本研究的目的是比较期待治疗与内镜括约肌切开术治疗急性胆石性胰腺炎患者小胆总管结石（≤5mm）的疗效。
回顾性分析 2010 年 1 月至 2014 年 12 月因急性胆石性胰腺炎入院的 258 例患者，其中 174 例有小胆总管结石。排除合并急性胆管炎和/或胰胆恶性肿瘤的患者。将他们分为内镜括约肌切开术组（n = 64）和期待治疗组（n = 110）。比较胰腺炎的严重程度指数和结局、并发症及总体死亡率。
两组患者的年龄和性别无显著差异。两组间的平均兰森评分、急性生理与慢性健康状况评分系统 II 以及急性胰腺炎床边严重程度指数评分无显著差异。期待治疗组的计算机断层扫描严重程度指数评分显著高于内镜括约肌切开术组（1.6±1.1 vs. 1.0±0.9，P<0.001）。两组的住院时间、白细胞计数恢复正常的时间以及开始经口进食的时间相似。两组间假性囊肿或包裹性坏死的发生率无显著差异。此外，急性胰腺炎复发率和因复发性胆总管结石再次入院率也无差异。
对于急性胆石性胰腺炎且胆管结石大小等于或小于 5mm 的患者，期待治疗似乎有效。
