Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea.
Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA.
Gut Liver. 2021 Jan 15;15(1):128-134. doi: 10.5009/gnl19380.
BACKGROUND/AIMS: This study assessed the significance of biliary stricture in symptomatic chronic pancreatitis patients requiring extracorporeal shock wave lithotripsy (ESWL) and endoscopic retrograde cholangiopancreatography (ERCP) to remove obstructing pancreatic calculi.
A total of 97 patients underwent ESWL followed by ERCP to remove pancreatic calculi between October 2014 and October 2017 at Virginia Mason Medical Center. Significant biliary stricture (SBS) was defined as a stricture with upstream dilation on computed tomography scan or magnetic resonance cholangiopancreatography scans accompanied by cholestasis and/or cholangitis. SBS was initially managed by either a plastic stent or fully covered self-expandable metallic stent (fcSEMS). If the stricture did not resolve, the stent was replaced with either multiple plastic stents or another fcSEMS. Data were collected by retrospectively reviewing the medical records.
Biliary strictures were noted in approximately one-third of patients (34/97, 35%) undergoing ESWL for pancreatic calculi. Approximately one-third of the biliary strictures (11/34, 32%) were SBS. Pseudocysts were more frequently found in those with SBS (36% vs 8%, p=0.02), and all pseudocysts in the SBS group were located in the pancreatic head. The initial stricture resolution rates with fcSEMSs and plastic prostheses were 75% and 29%, respectively. The overall success rate for stricture resolution was 73% (8/11), and the recurrence rate after initial stricture resolution was 25% (2/8).
Although periductal fibrosis is the main mechanism underlying biliary stricture development in chronic pancreatitis, inflammation induced by obstructing pancreatic calculi, including pseudocysts, is an important contributing factor to SBS formation during the acute phase.
背景/目的：本研究评估了需要体外冲击波碎石术（ESWL）和内镜逆行胰胆管造影术（ERCP）清除梗阻性胰结石的有症状慢性胰腺炎患者胆管狭窄的意义。
2014 年 10 月至 2017 年 10 月，弗吉尼亚梅森医疗中心共有 97 例患者接受 ESWL 后行 ERCP 以清除胰结石。有意义的胆管狭窄（SBS）定义为 CT 扫描或磁共振胰胆管造影扫描上存在狭窄伴上游扩张，并伴有胆汁淤积和/或胆管炎。SBS 最初通过塑料支架或全覆膜自膨式金属支架（fcSEMS）治疗。如果狭窄未缓解，则用多个塑料支架或另一个 fcSEMS 更换支架。通过回顾性查阅病历收集数据。
在接受 ESWL 治疗胰结石的患者中，约有三分之一（34/97，35%）发现胆管狭窄。约三分之一的胆管狭窄（11/34，32%）为 SBS。SBS 组更常发现假性囊肿（36% vs 8%，p=0.02），SBS 组所有假性囊肿均位于胰头部。fcSEMS 和塑料假体的初始狭窄缓解率分别为 75%和 29%。狭窄缓解的总体成功率为 73%（8/11），初始狭窄缓解后复发率为 25%（2/8）。
尽管胰管周围纤维化是慢性胰腺炎胆管狭窄发展的主要机制，但阻塞性胰结石引起的炎症，包括假性囊肿，是急性阶段 SBS 形成的重要因素。
