Digestive Diseases Unit, Sant'Andrea Hospital, Sapienza University of Rome, Italy.
Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Centre, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Pancreatology. 2019 Mar;19(2):237-244. doi: 10.1016/j.pan.2019.01.022. Epub 2019 Jan 31.
BACKGROUND/OBJECTIVES: Data estimating the prevalence of significant findings during the investigation of patients with Chronic Asymptomatic Pancreatic Hyperenzymemia (CAPH) are scanty and heterogeneous, and the diagnostic approach is therefore uncertain. The aim of this study was to meta-analyze pancreatic abnormalities detected at second-level imaging in patients with CAPH.
Pubmed database was searched until September 2018 for articles evaluating CAPH patients through MRI-Cholangio-Pancreatography with/without secretin (MRCP or s-MRCP) or Endoscopic Ultrasound (EUS). The methodology was developed from PRISMA checklist. Pooled prevalences of pancreatic findings were calculated, with subgroup analyses according to imaging modality. Quality of the studies, publication bias and heterogeneity were analyzed.
In 8 articles describing 521 patients with CAPH, pooled prevalence of normal imaging was 56.6% [95%CI (CI) 41.9-70.2; I = 88.6%). Prevalences of neoplasia, chronic pancreatitis, pancreatic cysts and benign abnormalities were 2.2% [CI1.2-4.1; I = 0%], 16.2% [CI10.2-24.8; I = 71.5%], 12.8% [CI8.2-19.3; I = 64.7%] and 17.2% [CI11.9-24.2; I = 71.5%] respectively. In sub-analyses, EUS and s-CPRM were less frequently normal and diagnosed more "early" chronic pancreatitis, while neoplastic lesions were still rare.
In CAPH patients, second-level pancreatic imaging is normal in 56% of the cases, neoplastic lesions are rare and the rate of pancreatic cysts is similar to that seen as incidental findings. More than one third of patients are diagnosed with abnormalities whose prognostic significance is uncertain. Despite the superior sensitivity of EUS or s-CPRM, the less costly/invasive and more available contrast-enhanced MRCP does not seem to miss relevant findings in this setting.
背景/目的：关于慢性无症状性胰腺高酶血症（CAPH）患者在调查过程中发现显著异常的患病率数据稀缺且存在异质性，因此诊断方法不确定。本研究的目的是对 CAPH 患者二级影像学检查发现的胰腺异常进行荟萃分析。
检索 Pubmed 数据库，截至 2018 年 9 月，评估通过 MRI-胆胰管成像（MRCP 或 s-MRCP）或内镜超声（EUS）检查 CAPH 患者的文章。方法是按照 PRISMA 清单制定的。计算胰腺异常的总患病率，并根据影像学方式进行亚组分析。分析研究质量、发表偏倚和异质性。
在 8 篇描述 521 例 CAPH 患者的文章中，影像学正常的总患病率为 56.6%[95%可信区间（CI）为 41.9-70.2；I=88.6%]。肿瘤、慢性胰腺炎、胰腺囊肿和良性异常的患病率分别为 2.2%[CI1.2-4.1；I=0%]、16.2%[CI10.2-24.8；I=71.5%]、12.8%[CI8.2-19.3；I=64.7%]和 17.2%[CI11.9-24.2；I=71.5%]。在亚组分析中，EUS 和 s-MRCP 较少见正常，且更早地诊断出慢性胰腺炎，而肿瘤病变仍然罕见。
在 CAPH 患者中，二级胰腺影像学检查有 56%正常，肿瘤病变罕见，胰腺囊肿的发生率与偶然发现的相似。三分之一以上的患者被诊断为异常，但其预后意义不确定。尽管 EUS 或 s-MRCP 的敏感性更高，但成本更低/侵入性更小、更易获得的增强型 MRCP 在这种情况下似乎不会遗漏相关发现。
