Valverde-López Francisco, Ortega-Suazo Eva Julissa, Wilcox Charles Mel, Fernandez-Cano Maria Carmen, Martínez-Cara Juan Gabriel, Redondo-Cerezo Eduardo
Department of Gastroenterology and Hepatology, "Virgen de las Nieves" University Hospital, Complejo Hospitalario Universitario de Granada, Granada, Spain (Francisco Valverde-López, Eva Julissa Ortega-Suazo, Maria Carmen Fernandez-Cano, Juan Gabriel Martínez-Cara, Eduardo Redondo-Cerezo).
Division of Gastroenterology and Hepatology and Pancreaticobiliary Center, University of Alabama at Birmingham, USA (Charles Mel Wilcox).
Ann Gastroenterol. 2020 May-Jun;33(3):305-312. doi: 10.20524/aog.2020.0464. Epub 2020 Mar 14.
Endoscopic ultrasound (EUS) is useful in the diagnostic workup of idiopathic acute pancreatitis but its role as a predictor of recurrence has not been thoroughly assessed. Our aim was to study the performance of EUS in idiopathic acute pancreatitis, its impact on the natural history of the disease, and the factors related to recurrence.
Patients with idiopathic acute pancreatitis referred to our endoscopy unit were enrolled and followed, with assessment of the performance of endoscopic retrograde cholangiopancreatography (ERCP), cholecystectomy, and the incidence of recurrence. EUS findings and recurrence rates were compared between patients with a first episode or recurrent attacks and in patients with previous cholecystectomy versus those with gallbladder in situ.
One hundred six patients were included (mean follow up: 53.59±27.79 months). Biliary disease related to stones was the most common finding on EUS (49.1%), and patients referred for recurrent attacks showed the highest recurrence rate during follow up (57.1%). ERCP or cholecystectomy reduced recurrences to 14.3% in patients with biliary disease. Age under 65 (odds ratio [OR] 3.56, 95% confidence interval [CI] 1.21-10.44; P=0.02), previous cholecystectomy (OR 3.19, 95%CI 1.11-9.17; P=0.03), and no lithiasis on EUS (OR 2.87, 95%CI 1.04-7.87; P=0.04) were independent risks factors for recurrence.
EUS-directed ERCP/cholecystectomy was associated with lower relapse rates in idiopathic acute pancreatitis. Along with age and gallbladder status, it provides predictive information about recurrence likelihood.
内镜超声（EUS）在特发性急性胰腺炎的诊断检查中很有用，但它作为复发预测指标的作用尚未得到充分评估。我们的目的是研究EUS在特发性急性胰腺炎中的表现、其对疾病自然史的影响以及与复发相关的因素。
纳入转诊至我们内镜科的特发性急性胰腺炎患者并进行随访，评估内镜逆行胰胆管造影（ERCP）、胆囊切除术的实施情况以及复发率。比较首次发作或复发患者之间以及既往行胆囊切除术患者与胆囊原位患者之间的EUS检查结果和复发率。
共纳入106例患者（平均随访时间：53.59±27.79个月）。EUS检查最常见的发现是与结石相关的胆道疾病（49.1%），而复发性发作患者在随访期间的复发率最高（57.1%）。ERCP或胆囊切除术使胆道疾病患者的复发率降至14.3%。年龄小于65岁（比值比[OR] 3.56，95%置信区间[CI] 1.21 - 10.44；P = 0.02）、既往行胆囊切除术（OR 3.19，95%CI 1.11 - 9.17；P = 0.03）以及EUS检查无结石（OR 2.87，95%CI 1.04 - 7.87；P = 0.04）是复发的独立危险因素。
EUS引导下的ERCP/胆囊切除术与特发性急性胰腺炎较低的复发率相关。连同年龄和胆囊状态，它提供了关于复发可能性的预测信息。
