Department of Medicine II, LMU University Hospital, Munich, Germany.
Department of Gastroenterology, Hepatology, and Oncology, Medical Center for Postgraduate Education, Warsaw, Poland.
Gut. 2023 Oct;72(10):1919-1926. doi: 10.1136/gutjnl-2022-327955. Epub 2023 Apr 18.
In up to 20% of patients, the aetiology of acute pancreatitis (AP) remains elusive and is thus called idiopathic. On more detailed review these cases can often be explained through biliary disease and are amenable to treatment. Findings range from biliary sludge to microlithiasis but their definitions remain fluid and controversial.
A systematic literature review (1682 reports, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines) analysed definitions of biliary sludge and microlithiasis, followed by an online international expert survey (30 endoscopic ultrasound/hepatobiliary and pancreatic experts; 36 items) which led to definitions of both. These were consented by Delphi voting and clinically evaluated in a retrospective cohort of patients with presumed biliary pancreatitis.
In 13% of original articles and 19.2% of reviews, microlithiasis and biliary sludge were used synonymously. In the survey, 41.7% of experts described the term 'sludge' and 'microlithiasis' as identical findings. As a consequence, three definitions were proposed, agreed on and confirmed by voting to distinctly discriminate between biliary sludge (hyperechoic material without acoustic shadowing) and microlithiasis (echorich calculi of ≤5 mm with acoustic shadowing) as opposed to larger biliary stones, both for location in gallbladder and bile ducts. In an initial attempt to investigate the clinical relevance in a retrospective analysis in 177 confirmed cases in our hospital, there was no difference in severity of AP if caused by sludge, microlithiasis or stones.
We propose a consensus definition for the localisation, ultrasound morphology and diameter of biliary sludge and microlithiasis as distinct entities. Interestingly, severity of biliary AP was not dependent on the size of concrements warranting prospective randomised studies which treatment options are adequate to prevent recurrence.
在多达 20%的急性胰腺炎（AP）患者中，病因仍然难以捉摸，因此被称为特发性。通过更详细的回顾，这些病例通常可以通过胆道疾病来解释，并可以进行治疗。发现的范围从胆泥到微结石，但它们的定义仍然模糊和有争议。
系统文献综述（遵循系统评价和荟萃分析的首选报告项目指南，共 1682 份报告）分析了胆泥和微结石的定义，随后进行了在线国际专家调查（30 名内镜超声/肝胆胰专家；36 项），从而得出了这两种定义。这些定义通过德尔菲投票达成一致，并在一个假定为胆源性胰腺炎的患者回顾性队列中进行了临床评估。
在原始文章的 13%和综述的 19.2%中，微结石和胆泥被同义使用。在调查中，41.7%的专家将术语“sludge”和“microlithiasis”描述为相同的发现。因此，提出了三个定义，通过投票达成一致，并确认可以清楚地区分胆囊和胆管中的胆泥（无声影的高回声物质）和微结石（回声丰富的直径≤5mm 的结石伴声影）与较大的胆道结石，所有这些都用于位置。在我们医院的一项回顾性分析中，对 177 例确诊病例进行了初步尝试，以研究其临床相关性，如果 AP 是由胆泥、微结石还是结石引起，其严重程度没有差异。
我们提出了一个关于胆泥和微结石在局部、超声形态和直径方面的共识定义，作为不同的实体。有趣的是，胆道 AP 的严重程度不取决于结石的大小，需要前瞻性随机研究来确定适当的治疗方案以预防复发。
