Department of Gastroenterology, PGIMER, Chandigarh, India.
Department of Gastroenterology, AIIMS, Rishikesh, India.
Pancreatology. 2020 Dec;20(8):1567-1575. doi: 10.1016/j.pan.2020.10.035. Epub 2020 Oct 12.
Coronavirus disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has led to a world-wide pandemic since its onset in December of 2019. Although, a primary respiratory pathogen, over the ensuing period, its extra-pulmonary effects have come to the forefront. The virus, having multi-organ tropism, has been shown to affect a host of other organs beyond the lung, including the pancreas. The data on pancreatic involvement by COVID-19, however, have been limited. Moreover, whether the effects on the pancreas are due to the direct effects of the virus or is just an epi-phenomenon is debatable. The prevalence of pancreatic injury and degree of injury are the other issues that need to be addressed. Pancreatic cancer has a dismal prognosis and the management of the same in the COVID era needs to be tailored assessing the risk-benefit ratio for the same. Additionally, pancreatic surgery increases not only the morbidity of the patient, but also the risk of the operator and burden on the health care system. Hence, the decision for such major procedures needs to be rationalized for optimum benefit during this pandemic. Similarly, for the endoscopist, pancreatic endoscopy needs to be carefully regulated to reduce risk to both the patient and the physician and yet deliver optimum patient care. This review gives a concise summary of various aspects of pancreatic involvement and pancreatic disease management during this pandemic.
由严重急性呼吸系统综合征冠状病毒 2(SARS-CoV-2)引起的 2019 年冠状病毒病(COVID-19)自 2019 年 12 月爆发以来,已在全球范围内引发大流行。尽管这是一种主要的呼吸道病原体,但在此后的时期,其肺外效应已成为关注焦点。该病毒具有多器官趋向性,已被证明会影响除肺以外的许多其他器官,包括胰腺。然而,关于 COVID-19 对胰腺的影响的数据有限。此外,对胰腺的影响是由于病毒的直接作用还是仅仅是一种表型现象仍存在争议。需要解决的其他问题是胰腺损伤的普遍性和损伤程度。胰腺癌预后不良,因此在 COVID 时代需要根据风险效益比来评估和管理同一疾病。此外,胰腺手术不仅会增加患者的发病率,还会增加手术医生的风险并加重医疗保健系统的负担。因此,需要在大流行期间合理决定进行此类主要手术,以获得最佳收益。同样,对于内镜医生,也需要仔细规范胰腺内镜检查,以降低患者和医生的风险,同时提供最佳的患者护理。这篇综述简要总结了在大流行期间胰腺受累和胰腺疾病管理的各个方面。