Michael Florian Alexander, Feldmann Clara, Erasmus Hans-Peter, Kubesch Alica, Goerguelue Esra, Knabe Mate, Abedin Nada, Heilani Myriam, Hessz Daniel, Graf Christiana, Walter Dirk, Finkelmeier Fabian, Mihm Ulrike, Lingwal Neelam, Zeuzem Stefan, Bojunga Joerg, Friedrich-Rust Mireen, Dultz Georg
Medical Clinic 1, Goethe University Frankfurt Frankfurt University Hospital, Frankfurt am Main, Germany.
Centrum Gastroenterology Bethanien, Bethanien-Hospital, Frankfurt am Main, Germany.
Ultraschall Med. 2025 Apr;46(2):177-185. doi: 10.1055/a-2407-9651. Epub 2024 Sep 2.
Before removal of retained pancreatic stents placed during endoscopic retrograde cholangiopancreatography to avoid post-ERCP pancreatitis, imaging is recommended. The aim of the present study was to evaluate a new ultrasound-based algorithm.Patients who received a pancreatic stent for PEP prophylaxis were included. Straight 5Fr (0.035inch) 6cm stents with an external flap that were visualized by ultrasound were removed endoscopically with no further imaging. If the ultrasound result reported the stent to be dislodged or was inconclusive, X-ray imaging was performed. The endpoints were positive and negative predictive value, specificity, sensitivity, and contingency coefficient between ultrasound and X-ray and/or endoscopy.88 patients were enrolled in the present study. X-ray was performed in 23 (26%) patients. Accordingly, the ultrasound algorithm saved an X-ray examination in 65 cases, leading to a reduction of 74%. Stents were retained in 67 patients (76%) and visualized correctly by ultrasound in 54 patients with a sensitivity of 81%. The positive predictive value was 83%. The specificity was 48%, because ultrasound described 10/21 dislodged stents correctly. The negative predictive value was 43%, since 10/23 stents were correctly classified by ultrasound as dislodged. In 11 patients (13%), esophagogastroduodenoscopy was performed even though the pancreatic stent was already dislodged.A novel ultrasound-based algorithm reduced the need for X-ray imaging by three quarters. To avoid unnecessary endoscopic examinations, the algorithm should be implemented with a learning phase and procedures should be performed by experienced examiners. An important limitation might be stent length since shorter stents might be more difficult to visualize by ultrasound.
在内镜逆行胰胆管造影术期间放置的用于预防内镜逆行胰胆管造影术后胰腺炎的留置胰管支架取出前，建议进行影像学检查。本研究的目的是评估一种基于超声的新算法。纳入了因预防内镜逆行胰胆管造影术后胰腺炎而置入胰管支架的患者。使用超声可显影的带有外部瓣膜的直形5Fr（0.035英寸）6cm支架在内镜下取出，无需进一步影像学检查。如果超声结果显示支架移位或结果不明确，则进行X线成像。观察指标为超声与X线和/或内镜检查之间的阳性和阴性预测值、特异性、敏感性和列联系数。本研究共纳入88例患者。23例（26%）患者进行了X线检查。因此，超声算法在65例患者中避免了X线检查，减少了74%。67例患者（76%）的支架被留置，54例患者的支架经超声正确显影，敏感性为81%。阳性预测值为83%。特异性为48%，因为超声正确描述了21个移位支架中的10个。阴性预测值为43%，因为23个支架中有10个被超声正确分类为移位。11例患者（13%）即使胰管支架已经移位仍进行了食管胃十二指肠镜检查。一种基于超声的新算法将X线成像的需求减少了四分之三。为避免不必要的内镜检查，该算法应在学习阶段实施，且操作应由经验丰富的检查人员进行。一个重要的局限性可能是支架长度，因为较短的支架可能更难通过超声显影。
