Departments of Internal Medicine, Fukuyama City Hospital, 5-23-1, Zao-cho, Fukuyama-City, Hiroshima, 721-8511, Japan.
Department of Gastroenterology and Hepatology, Okayama University Hospital, 2-5-1, Shikata-cho, Kita-ku, Okayama-City, Okayama, 700-8558, Japan.
BMC Gastroenterol. 2021 Jan 7;21(1):21. doi: 10.1186/s12876-020-01590-8.
The histological diagnosis of autoimmune pancreatitis (AIP) by an endoscopic ultrasound (EUS)-guided approach is still challenging.
We investigated the utility of the 21-gauge Menghini-type biopsy needle with the rolling method for the histological diagnosis of AIP, in comparison with conventional 22-gauge needles. Among total 28 patients, rate of definitive histological diagnosis, acquired sample area of tissue, rate of histopathological diagnosis of AIP, and adverse events were retrospectively analyzed.
Definitive histological diagnoses were successfully accomplished in all 14 patients (100%) treated with a Menghini-type needle, and in 57% of cases (8/14) treated with conventional 22-gauge needles (P < 0.001). The median sample area of the tissue, except for blood contamination, was remarkably larger by the Menghini-type needle than by conventional-type needles (6.2 [IQR, 4.5-8.8] versus 0.7 [IQR, 0.2-2.0] mm, P < 0.001), and the area per punctures was approximately 4 times larger (1.4 [IQR: 0.9-2.9] versus 0.3 [IQR: 0.1-0.6] mm/puncture, P < 0.001). Based on the International Consensus Diagnostic Criteria, lymphoplasmacytic infiltration, abundant IgG4-postive cells, storiform fibrosis, and obliterative phlebitis were found in 86%/29%, 64%/0%, 36%/0%, and 7%/0% patients who were treated with the Menghini-type needle and conventional-type needles, respectively. Consequently, histopathological diagnosis with type 1 AIP (lever 1 or 2) was achieved in 9 patients (64%) treated with the Menghini-type needle and in no patient treated with conventional-type needles (P < 0.001). Two patients who had mild post-procedural pancreatitis improved with conservative treatment, and no bleeding occurred in patients treated with the Menghini-type needle.
EUS-guided rolling method with the 21-gauge Menghini-type biopsy needle is useful for the histopathological diagnosis of AIP, due to its abundant acquisition of good-quality tissue from the pancreas.
经内镜超声（EUS）引导的自身免疫性胰腺炎（AIP）的组织学诊断仍然具有挑战性。
我们研究了 21G 孟氏型活检针的滚动法在 AIP 组织学诊断中的应用，并与传统的 22G 针进行了比较。回顾性分析了 28 例患者的明确组织学诊断率、获得的组织面积、AIP 的组织病理学诊断率和不良事件。
14 例（100%）患者使用孟氏型针成功完成了明确的组织学诊断，8 例（57%）患者使用传统的 22G 针（P < 0.001）。除了血液污染外，孟氏型针的组织样本面积中位数明显大于传统型针（6.2[IQR，4.5-8.8] vs 0.7[IQR，0.2-2.0]mm，P < 0.001），每个穿刺点的面积约为 4 倍（1.4[IQR：0.9-2.9] vs 0.3[IQR：0.1-0.6]mm/穿刺点，P < 0.001）。根据国际共识诊断标准，14 例患者中有 8 例（86%/29%）发现淋巴细胞浆细胞浸润、大量 IgG4 阳性细胞、纤维组织增生和闭塞性静脉炎，6 例（64%/0%）发现淋巴细胞浆细胞浸润、大量 IgG4 阳性细胞，3 例（36%/0%）发现纤维组织增生和闭塞性静脉炎，7 例（7%/0%）发现淋巴细胞浆细胞浸润、大量 IgG4 阳性细胞、纤维组织增生和闭塞性静脉炎。因此，14 例患者中有 9 例（64%）经孟氏型针治疗后获得 1 型 AIP（1 级或 2 级）的组织病理学诊断，而经传统型针治疗的患者无一例获得（P < 0.001）。2 例患者出现轻度术后胰腺炎，经保守治疗后好转，孟氏型针治疗患者无出血。
EUS 引导的 21G 孟氏型活检针滚动法对于 AIP 的组织病理学诊断是有用的，因为它可以从胰腺中获得大量高质量的组织。
