Department of Gastroenterology, Iwata City Hospital, Iwata, Japan.
Department of Gastroenterology, Asahi Rosai Hospital, Owariasahi, Japan.
Scand J Gastroenterol. 2021 Jul;56(7):865-869. doi: 10.1080/00365521.2021.1922747. Epub 2021 May 17.
Post-ERCP pancreatitis (PEP) after self-expandable metallic stent (SEMS) insertion across the papilla of Vater is an important adverse event that affects the patient's quality of life (QOL). We examined the predictive factors of PEP after SEMS insertion to treat obstructive jaundice due to malignancy.
Ninety patients who underwent biliary SEMS insertion for biliary obstruction due to malignancy at Iwata City Hospital between 2010 and 2018 were reviewed. We evaluated the relationship between the incidence of PEP after biliary SEMS insertion and clinical factors. We measured the thickness of the pancreatic parenchyma and diameter of the main pancreatic duct (MPD) at the left side of the corpus vertebrae.
Mild and severe PEP were diagnosed in 10 (11.1%) and 1 (1.1%) patients, respectively. Only the thickness of the pancreatic parenchyma and diameter of MPD significantly differed between the PEP and non-PEP groups. The incidence of PEP among patients whose thickness of the pancreatic parenchyma at the left side of the corpus vertebrae was less than 9.5 mm (0%) on computed tomography was lower than that in patients whose thickness was 9.5 mm or greater (34.4%). Similarly, a wider (5 mm or more) diameter of MPD (4.3%) reduced the incidence of PEP compared with a narrower diameter (40.0%). Logistic regression analysis revealed that the probability of PEP decreases 3.91 times for every 1-mm increase in MPD diameter (95% CI 1.23-12.4, = .02).
Based on our study, a dilated MPD is a negative predictive factor of pancreatitis related to biliary SEMS insertion.
经乳头内镜下逆行胰胆管造影（ERCP）后自膨式金属支架（SEMS）置入后发生胰腺炎（PEP）是影响患者生活质量（QOL）的重要不良事件。我们研究了 SEMS 置入治疗恶性肿瘤所致阻塞性黄疸后发生 PEP 的预测因素。
回顾性分析 2010 年至 2018 年Iwata 市医院因恶性肿瘤所致胆道阻塞行胆道 SEMS 置入的 90 例患者。我们评估了胆道 SEMS 置入后发生 PEP 的发生率与临床因素的关系。我们测量了椎体左侧胰腺实质厚度和主胰管（MPD）直径。
10 例（11.1%）和 1 例（1.1%）患者分别诊断为轻度和重度 PEP。只有胰腺实质厚度和 MPD 直径在 PEP 组和非 PEP 组之间有显著差异。在 CT 上胰腺实质厚度小于 9.5mm（0%）的患者中，PEP 的发生率低于厚度为 9.5mm 或以上的患者（34.4%）。同样，MPD 直径较宽（5mm 或以上）（4.3%）与较窄直径（40.0%）相比，降低了 PEP 的发生率。Logistic 回归分析显示，MPD 直径每增加 1mm，PEP 的概率降低 3.91 倍（95%CI 1.23-12.4， = .02）。
根据我们的研究，扩张的 MPD 是与胆道 SEMS 置入相关的胰腺炎的负预测因素。
