Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany.
Institute of Biostatistics and Mathematical Modeling, Frankfurt, Germany.
United European Gastroenterol J. 2021 May;9(4):469-477. doi: 10.1002/ueg2.12063. Epub 2021 Apr 22.
Before performing endoscopy to remove prophylactic pancreatic stents placed in patients with high risk of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP), X-ray imaging is recommended to confirm the stents position in the pancreatic duct.
The aim of the present study was to investigate the feasibility of prophylactic pancreatic stent detection by transabdominal ultrasonography, to reduce the burden of X-ray imaging, which is currently the golden standard.
All patients who received a pancreatic stent for PEP prophylaxis were included in the present prospective trial. First, stent position was determined by transabdominal ultrasonography. Afterwards, it was verified by X-ray imaging. Retained stents were removed by esophagogastroduodenoscopy. Dislocated stents needed no further intervention.
Fourty-one patients were enrolled in this study. All prophylactic pancreatic stents were straight 6 cm long 5 Fr stents with external flap. All stents were removed between day 1 and 10 (median: 3 days) in all cases. In 34 of 41 cases (83.0%), the pancreatic stent was still in place on the day of examination. Twenty-nine of 34 (85.3%) stents were detected correctly by transabdominal ultrasonography. Overlying gas prevented visualization of the pancreas in 3/41 (7.3%) cases. Sensitivity of sonographic detection of the stent was 93.5% (29/31). Six of seven stents were determined correctly as dislocated by ultrasonography. Here, specificity was 85.7%. A positive predictive value of 96.7% (29/30) was examined. The negative predictive value was 75.0% (6/8).
Transabdominal ultrasonography detects the majority of prophylactic pancreatic stents. Thereby, it helps to identify patients with an indication for endoscopy sufficiently. X-ray imaging could subsequently be omitted in about 70% of examinations, reducing the radiation exposure for the patient and the endoscopy staff.
在对有发生内镜逆行胰胆管造影术后胰腺炎（PEP）高危风险的患者进行预防性胰管支架取出之前，推荐进行 X 射线成像以确认支架在胰管中的位置。
本研究旨在探讨经腹超声检查对预防性胰管支架检测的可行性，以减少目前作为金标准的 X 射线成像的负担。
所有接受预防性胰管支架置入以预防 PEP 的患者均纳入本前瞻性试验。首先，通过经腹超声检查确定支架位置。随后，通过 X 射线成像进行验证。通过食管胃十二指肠镜取出残留的支架。支架位置错位者无需进一步干预。
本研究共纳入 41 例患者。所有预防性胰管支架均为直的 6cm 长 5Fr 外部瓣状支架。所有支架均在所有病例的第 1 天至第 10 天（中位数：3 天）之间取出。在 41 例患者中，有 34 例（83.0%）在检查日支架仍在位。34 例中有 29 例（85.3%）经经腹超声正确检测到支架。41 例中有 3 例（7.3%）因上方气体遮挡而无法观察胰腺。超声检测支架的敏感性为 93.5%（29/31）。6 例超声判断为支架位置错位的患者均经证实。特异性为 85.7%。阳性预测值为 96.7%（29/30）。阴性预测值为 75.0%（6/8）。
经腹超声可检测大多数预防性胰管支架。因此，它有助于充分识别需要进行内镜检查的患者。随后，大约 70%的检查可以省略 X 射线成像，从而减少患者和内镜工作人员的辐射暴露。
