Department of Gastroenterology and Hepatology, Japanese Red Cross Okayama Hospital.
Acta Med Okayama. 2020 Dec;74(6):475-481. doi: 10.18926/AMO/61206.
The insertion of a self-expandable metal stent (SEMS) for nonpancreatic cancer is a factor predicting the risk of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). We evaluated the efficacy of endo-scopic pancreatic stenting (EPS) to prevent PEP after SEMS insertion in patients with malignant distal biliary stricture and without main pancreatic duct (MPD) obstruction. We performed a single-center, retrospective, historically controlled investigation to assess the outcomes of 33 consecutive patients who underwent SEMS insertion. From March 2013 to June 2015, 13 patients did not undergo EPS (Non-EPS group). The other 20 patients underwent EPS (EPS group) between July 2015 and August 2018. The background data demonstrated no significant differences. Except for one patient in the Non-EPS group, all patients underwent biliary sphinc-terotomy. The EPS group's PEP incidence was significantly lower (n = 1, 5%) than that of the Non-EPS group (n = 4, 31%) (p = 0.04). The median serum amylase and lipase levels after the procedure were significantly lower in the EPS group than in the Non-EPS group (amylase: 104 vs. 262 U/L; p < 0.01, lipase: 102 vs. 666 U/L; p = 0.01). The use of EPS decreased the incidence of PEP after SEMS insertion in individuals with malignant distal biliary stricture and without MPD obstruction.
在非胰腺癌患者中，支架置入术（SEMS）的插入是预测内镜逆行胰胆管造影术后胰腺炎（PEP）风险的一个因素。我们评估了内镜胰管支架置入术（EPS）在没有主胰管（MPD）阻塞的恶性远端胆管狭窄患者中预防 SEMS 插入后 PEP 的疗效。我们进行了一项单中心回顾性历史对照研究，以评估 33 例连续接受 SEMS 插入的患者的结果。2013 年 3 月至 2015 年 6 月，13 例患者未行 EPS（非 EPS 组）。其余 20 例患者于 2015 年 7 月至 2018 年 8 月期间行 EPS（EPS 组）。背景数据无显著差异。除了非 EPS 组的一名患者外，所有患者均行胆胰管括约肌切开术。EPS 组 PEP 发生率明显低于非 EPS 组（n = 1，5% vs. n = 4，31%）（p = 0.04）。EPS 组术后血清淀粉酶和脂肪酶水平中位数明显低于非 EPS 组（淀粉酶：104 比 262 U/L；p < 0.01，脂肪酶：102 比 666 U/L；p = 0.01）。在没有 MPD 阻塞的恶性远端胆管狭窄患者中，SEMS 插入后使用 EPS 可降低 PEP 的发生率。
