Loloi Justin, Lipkin Jacob S, Gagliardi Eileen M, Levenick John M
Penn State College of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA.
Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Ther Adv Gastrointest Endosc. 2019 Jul 16;12:2631774519862895. doi: 10.1177/2631774519862895. eCollection 2019 Jan-Dec.
Pancreatic duct stents are frequently placed for prophylaxis of post-endoscopic retrograde cholangiopancreatography pancreatitis. Because of concern for possible secondary ductal changes from a retained stent, these stents need to be monitored and removed if retained. Usually an abdominal X-ray is performed to assess retained stent, and if present, an esophagogastroduodenoscopy is performed to remove the stent. Limited data is published on false-negative radiology reports for spontaneous passage of stents.
Using an Institutional Review Board-approved stent log, a retrospective chart review of all pancreatic duct stents placed at our institution from 2008 to 2014 was performed.
A total of 856 pancreatic duct stents were placed during the study period. Of these, 435 (50.8%) were prophylactic stents and 421 (49.2%) were therapeutic. Complete follow-up data were available in 426 (97.9%) patients with prophylactic stents. Six patients (1.4%) were lost to follow up and three (0.7%) expired prior to removal. In all, 283 (66%) had follow-up imaging, with 167 (39.2%) having the official radiology read with no retained pancreatic duct stent in place. Eight of these cases were "false-negative" radiology interpretation (4.8% of cases read as "no stent," NNH = 20). The stent was found either by review of image by an endoscopist or incidental stent discovery during a follow-up procedure.
Radiologist interpretation of abdominal X-rays to assess spontaneous passage of prophylactic pancreatic ducts stents resulted in a false-negative interpretation in approximately 5% of cases. Independent review of the images by the endoscopist may be beneficial given unfamiliarity of these stents by radiologists.
胰管支架常用于预防内镜逆行胰胆管造影术后胰腺炎。由于担心留置支架可能导致继发性导管改变，这些支架需要进行监测，若有留置则需取出。通常通过腹部X线检查来评估支架是否留置，若有留置，则需进行食管胃十二指肠镜检查以取出支架。关于支架自行排出的放射学报告假阴性的数据报道有限。
使用经机构审查委员会批准的支架日志，对2008年至2014年在本机构放置的所有胰管支架进行回顾性病历审查。
在研究期间共放置了856个胰管支架。其中，435个（50.8%）为预防性支架，421个（49.2%）为治疗性支架。426例（97.9%）接受预防性支架治疗的患者有完整的随访数据。6例患者（1.4%）失访，3例（0.7%）在取出支架前死亡。共有283例（66%）进行了随访影像学检查，其中167例（39.2%）的官方放射学报告显示胰管无留置支架。其中8例为“假阴性”放射学解读（占解读为“无支架”病例的4.8%，需治疗人数=20）。这些病例中，支架要么是由内镜医师复查图像时发现，要么是在后续手术中偶然发现。
放射科医生对腹部X线进行解读以评估预防性胰管支架的自行排出情况时，约5%的病例出现假阴性解读。鉴于放射科医生对这些支架不熟悉，由内镜医师对图像进行独立复查可能有益。
