Digestive Endoscopy Unit, Hospital 9 de Julho, São Paulo, SP, Brazil.
Endoscopy Unit, Complexo Hospital de Clínicas, Universidade Federal do Paraná (UFPR); Hospital Erasto Gaertner, Curitiba, PR, Brazil.
Sci Rep. 2020 Mar 5;10(1):4132. doi: 10.1038/s41598-020-60941-3.
Acute pancreatitis (AP) is a common adverse event (AE) of endoscopic papillectomy (EP). Prophylactic plastic pancreatic stent (PPS) placement appears to prevent AP. We evaluated factors associated with post-EP AP by a retrospective analysis of patients with tumors of the duodenal papilla who underwent EP from January 2008 to November 2016 at 2 tertiary care centers. Clinical, laboratory, endoscopic ultrasound parameters, and PPS placement were evaluated. Seventy-two patients underwent EP (37 men), with mean age of 60.3 (31-88) years. Mean main pancreatic duct (MPD) diameter was 0.44 (0.18-1.8) cm. Mean tumor size was 1.8 (0.5-9.6) cm. Tumors were staged as uT1N0, uT2N0, and uT1N1 in 87.5%, 11.1%, and 1.4%. Thirty-eight AEs occurred in 33 (45.8%) patients, with no mortality. Total bilirubin, tumor size, MPD diameter, and PPS placement had odds ratios (ORs) of 0.82, 0.14, 0.00, and 6.43 for AP. Multivariate analysis (PPS placement × MPD diameter) showed ORs of 4.62 (95%CI, 1.03-21.32; p = 0.049) and 0.000 (95%CI, 0.00-0.74; p = 0.042) for AP. In conclusion, patients with jaundice, large tumors, and dilated MPD seem less likely to have post-EP AP. PPS placement was associated with a higher risk of AP, which may question its use.
急性胰腺炎（AP）是内镜乳头切开术（EP）的常见不良事件（AE）。预防性塑料胰腺支架（PPS）放置似乎可以预防 AP。我们通过对 2008 年 1 月至 2016 年 11 月在 2 家三级护理中心接受 EP 的十二指肠乳头肿瘤患者进行回顾性分析，评估了与 EP 后 AP 相关的因素。评估了临床、实验室、内镜超声参数和 PPS 放置情况。72 例患者接受 EP（37 例男性），平均年龄 60.3（31-88）岁。平均主胰管（MPD）直径为 0.44（0.18-1.8）cm。平均肿瘤大小为 1.8（0.5-9.6）cm。87.5%、11.1%和 1.4%的肿瘤分期为 uT1N0、uT2N0 和 uT1N1。33 例（45.8%）患者发生 38 例 AE，无死亡。总胆红素、肿瘤大小、MPD 直径和 PPS 放置的急性胰腺炎比值比（OR）分别为 0.82、0.14、0.00 和 6.43。多变量分析（PPS 放置×MPD 直径）显示 AP 的 OR 分别为 4.62（95%CI，1.03-21.32；p=0.049）和 0.000（95%CI，0.00-0.74；p=0.042）。总之，黄疸、大肿瘤和 MPD 扩张的患者发生 EP 后 AP 的可能性较小。PPS 放置与 AP 的风险增加相关，这可能对其使用提出质疑。
