Tarnasky P, Cunningham J, Cotton P, Hoffman B, Palesch Y, Freeman J, Curry N, Hawes R
Digestive Disease Center, Medical University of South Carolina, Charleston, USA.
Endoscopy. 1997 May;29(4):252-7. doi: 10.1055/s-2007-1004185.
The reason for the increased risk of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP) in patients with sphincter of Oddi dysfunction is not known. This study sought to determine whether pancreatic sphincter hypertension might explain some of the increased risk.
The incidence of pancreatitis was determined from a cohort of patients who underwent pancreatic sphincter manometry. Additional data collected included: pancreatic and biliary sphincter manometry results, distal bile duct diameter, chronic pancreatitis grade by pancreatography, and endoscopic treatments.
Ten of 32 patients (31%) with pancreatic sphincter hypertension developed post-ERCP pancreatitis, compared to one of 33 (3%) with normal pancreatic manometry (P = 0.002). Patients with pancreatic sphincter hypertension were more likely to undergo endoscopic treatments (88%) compared to those with normal manometry (27%) (P = 0.001). The distal bile duct diameter was significantly smaller (4.5 +/- 0.5 mm) in patients who developed post-ERCP pancreatitis than in those who did not (6.2 +/- 0.3) (P = 0.025). Patients with small distal bile duct diameters (< 5 mm) were three times more likely to develop post-ERCP pancreatitis than those with larger ducts (relative risk [RR] 3.1, 95% confidence interval [CI] 0.9, 10.7). Patients with pancreatic sphincter hypertension were ten times more likely to develop post-ERCP pancreatitis than those with normal pancreatic manometry (RR 10.3, 95% CI 1.5, 76.0). In patients with a small bile duct size, pancreatic sphincter hypertension substantially increased the risk compared to those with normal manometry (RR 18.1, 95% CI 1.1, 287.6).
Pancreatic sphincter hypertension greatly increases the risk of post-ERCP pancreatitis in patients undergoing treatment or evaluation, or both, for sphincter of Oddi dysfunction.
在患有奥迪括约肌功能障碍的患者中，内镜逆行胰胆管造影术（ERCP）后胰腺炎风险增加的原因尚不清楚。本研究旨在确定胰腺括约肌高压是否可以解释部分增加的风险。
从一组接受胰腺括约肌测压的患者中确定胰腺炎的发病率。收集的其他数据包括：胰腺和胆管括约肌测压结果、远端胆管直径、通过胰管造影术评估的慢性胰腺炎分级以及内镜治疗情况。
32例胰腺括约肌高压患者中有10例（31%）发生了ERCP术后胰腺炎，相比之下，33例胰腺测压正常的患者中有1例（3%）发生了术后胰腺炎（P = 0.002）。与测压正常的患者（27%）相比，胰腺括约肌高压患者更有可能接受内镜治疗（88%）（P = 0.001）。发生ERCP术后胰腺炎的患者远端胆管直径（4.5±0.5 mm）明显小于未发生胰腺炎的患者（6.2±0.3）（P = 0.025）。远端胆管直径小（<5 mm）的患者发生ERCP术后胰腺炎的可能性是胆管直径大的患者的三倍（相对风险[RR] 3.1，95%置信区间[CI] 0.9，10.7）。胰腺括约肌高压患者发生ERCP术后胰腺炎的可能性是胰腺测压正常患者的十倍（RR 10.3，95% CI 1.5，76.0）。在胆管尺寸小的患者中，与测压正常的患者相比，胰腺括约肌高压显著增加了风险（RR 18.1，95% CI 1.1，287.6）。
对于因奥迪括约肌功能障碍而接受治疗或评估或两者兼有的患者，胰腺括约肌高压会大大增加ERCP术后胰腺炎的风险。
