Department of Gastroenterology, Onomichi General Hospital, Onomichi, Japan.
Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka City, Japan.
PLoS One. 2021 Jan 19;16(1):e0245447. doi: 10.1371/journal.pone.0245447. eCollection 2021.
Endoscopic ultrasonography (EUS) is proven to be a more specific and sensitive method for detecting pancreatic lesions. However, usefulness of EUS after pancreatectomy has not been reported. This study aimed to evaluate the observational capability of EUS for the remnant pancreas (RP) after pancreatectomy.
This single-center, retrospective study enrolled 395 patients who underwent pancreatectomy at Onomichi General Hospital between December 2002 and March 2016, 45 patients who underwent EUS for RP were included for analysis. We evaluated the usefulness of EUS for RP using logistic regression analysis.
Complete observation of the RP was done in 42 patients (93%). In the initial surgical procedure, 21 patients underwent pancreaticoduodenectomy (PD), and 24 patients underwent distal pancreatectomy (DP). PD and DP were observed in 85% (18/21) and 100% (24/24) cases, respectively. A comparison of the detection capability of EUS and contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) showed that EUS was significantly superior to contrast-enhanced CT or MRI (p < 0.01). Eight of the 45 patients showed recurrence lesions in the RP. The median recurrence period was 33 months. Predictive factors for recurrence in the univariate and multivariate analyses were significantly different in space occupying lesion with EUS findings (p < 0.01) and elevated CA19-9(p < 0.01).
EUS was able to observe the RP in almost all cases. In addition, the detection capability of EUS was significantly superior to those of CT or MRI. We recommend that all patients with RP should undergo EUS, and a longer follow-up must be performed.
内镜超声检查（EUS）已被证实是一种更具特异性和敏感性的检测胰腺病变的方法。然而，EUS 在胰腺切除术后的应用尚未见报道。本研究旨在评估 EUS 对胰腺切除术后残胰（RP）的观察能力。
本单中心回顾性研究纳入了 2002 年 12 月至 2016 年 3 月期间在大分县总医院接受胰腺切除术的 395 例患者，其中 45 例行 EUS 检查 RP 用于分析。我们使用逻辑回归分析评估 EUS 对 RP 的有用性。
42 例（93%）患者 RP 完全可观察。在初始手术中，21 例行胰十二指肠切除术（PD），24 例行胰体尾切除术（DP）。PD 和 DP 的观察率分别为 85%（18/21）和 100%（24/24）。EUS 与增强 CT 或 MRI 的检测能力比较显示，EUS 明显优于增强 CT 或 MRI（p<0.01）。45 例患者中有 8 例在 RP 中出现复发病灶。中位复发期为 33 个月。单因素和多因素分析中，EUS 检查结果占位性病变和 CA19-9 升高是 RP 复发的预测因素（p<0.01）。
EUS 几乎可以观察到所有 RP。此外，EUS 的检测能力明显优于 CT 或 MRI。我们建议所有 RP 患者均应行 EUS 检查，并需进行更长时间的随访。
