Phillip Veit, Pukitis Aldis, Epstein Alexey, Hapfelmeier Alexander, Haf David, Schwab Miriam, Demir Ihsan Ekin, Rosendahl Jonas, Hoffmeister Albrecht, Schmid Roland M, Weber Andreas, Algül Hana
Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, München, Germany.
Pauls Stradins Clinical University Hospital, Center of Gastroenterology, Hepatology and Nutrition, Riga, Latvia.
Endosc Int Open. 2019 Jul;7(7):E860-E868. doi: 10.1055/a-0886-6384. Epub 2019 Jul 3.
Acute pancreatitis (AP) is one of the most common gastrointestinal disorders leading to hospitalization and the most frequent complication of endoscopic retrograde cholangiopancreatography (ERCP). Besides pharmaco-prophylaxis, pancreatic stenting has been demonstrated to protect from post-ERCP pancreatitis (PEP). However, it remains unclear which patients benefit from pancreatic stenting. We therefore hypothesized that in an unselected population, inadvertent cannulation of the pancreatic duct during first-time ERCP increases risk of PEP and that this risk can be significantly reduced by pancreatic stenting. This study was a multicenter, prospective, randomized controlled trial conducted at four European centers. A total of 167 patients undergoing first-time ERCP were enrolled in this trial. In the case of inadvertent cannulation of the pancreatic duct, patients were randomly assigned to receive either a 5 French plastic pancreatic stent of various length or no routine prophylactic intervention for PEP. A total of 167 patients were included in the final analysis. Prophylactic stent insertion significantly reduced the rate of PEP during first-time ERCP (odds ratio 0.43; 95% confidence interval 0.19 - 0.98; = 0.04). The number needed to treat to prevent one case of PEP by prophylactic stent insertion after inadvertent cannulation of the pancreatic duct was 8.1 for the intention-to-treat population. In an unselected patient population, inadvertent cannulation of the pancreatic duct during first-time ERCP is associated with a high risk for PEP. This risk can be significantly reduced by prophylactic pancreatic stenting, which is a safe and feasible procedure.
急性胰腺炎（AP）是导致住院的最常见胃肠道疾病之一，也是内镜逆行胰胆管造影术（ERCP）最常见的并发症。除了药物预防外，胰管支架置入已被证明可预防ERCP术后胰腺炎（PEP）。然而，尚不清楚哪些患者能从胰管支架置入中获益。因此，我们推测在未经过筛选的人群中，首次ERCP时意外插管进入胰管会增加PEP的风险，而这种风险可通过胰管支架置入显著降低。 本研究是在四个欧洲中心进行的一项多中心、前瞻性、随机对照试验。共有167例接受首次ERCP的患者纳入该试验。若意外插管进入胰管，患者被随机分配接受不同长度的5法式塑料胰管支架或不进行PEP的常规预防性干预。 共有167例患者纳入最终分析。预防性支架置入显著降低了首次ERCP期间PEP的发生率（比值比0.43；95%置信区间0.19 - 0.98； = 0.04）。对于意向性治疗人群，胰管意外插管后通过预防性支架置入预防一例PEP所需治疗的患者数为8.1。 在未经过筛选的患者人群中，首次ERCP时意外插管进入胰管与PEP的高风险相关。预防性胰管支架置入可显著降低这种风险，这是一种安全可行的操作。
