内镜超声对经内镜逆行胰胆管造影术发现的慢性胰腺炎进行诊断、排除或确定其严重程度能力的前瞻性评估。

Prospective assessment of the ability of endoscopic ultrasound to diagnose, exclude, or establish the severity of chronic pancreatitis found by endoscopic retrograde cholangiopancreatography.

作者信息

Sahai A V, Zimmerman M, Aabakken L, Tarnasky P R, Cunningham J T, van Velse A, Hawes R H, Hoffman B J

机构信息

Digestive Disease Center, Medical University of South Carolina, Charleston 29425-2220, USA.

出版信息

Gastrointest Endosc. 1998 Jul;48(1):18-25. doi: 10.1016/s0016-5107(98)70123-3.

DOI:10.1016/s0016-5107(98)70123-3

PMID:9684659

Abstract

BACKGROUND

Our aim was to verify endoscopic ultrasound (EUS) accuracy to diagnose, rule out, and establish the severity of chronic pancreatitis found by endoscopic retrograde cholangiopancreatography (ERCP).

METHODS

Patients undergoing ERCP for unexplained abdominal pain and/or suspected chronic pancreatitis underwent EUS. EUS was performed by experienced operators who were aware of the history but blinded to ERCP results. Chronic pancreatitis was defined using the Cambridge classification: 0 to 1 = "normal," 2 to 4 = "all chronic pancreatitis," 3 to 4 = "moderate to severe chronic pancreatitis." The number of EUS criteria required to obtain sensitivity, specificity, positive and negative predictive values > or = 85% was determined. EUS criteria for chronic pancreatitis are hyperechoic foci, hyperechoic strands, lobularity, hyperechoic duct, irregular duct, visible side-branches, ductal dilation, calcification, and cysts.

RESULTS

One hundred twenty-six patients underwent EUS and ERCP. EUS was highly sensitive and specific (> 85%) depending on the number of criteria present. Chronic pancreatitis is likely (PPV > 85%) when more than two criteria (for "all chronic pancreatitis") and more than six criteria (for "moderate to severe chronic pancreatitis") are present. "Moderate to severe chronic pancreatitis" is unlikely (NPV > 85%) when fewer than three criteria are present. Independent predictors of chronic pancreatitis were "calcification" (p = 0.000001), history of alcohol abuse (p = 0.002), and the total number of EUS criteria (p = 0.008).

CONCLUSIONS

EUS can accurately diagnose, rule out, and establish the severity of chronic pancreatitis found by ERCP.

摘要

背景

我们的目的是验证内镜超声（EUS）在诊断、排除以及确定经内镜逆行胰胆管造影（ERCP）发现的慢性胰腺炎严重程度方面的准确性。

方法

因不明原因腹痛和/或疑似慢性胰腺炎而接受ERCP的患者接受了EUS检查。EUS由了解病史但对ERCP结果不知情的经验丰富的操作人员进行。慢性胰腺炎采用剑桥分类法定义：0至1级 = “正常”，2至4级 = “所有慢性胰腺炎”，3至4级 = “中度至重度慢性胰腺炎”。确定获得灵敏度、特异度、阳性和阴性预测值≥85%所需的EUS标准数量。慢性胰腺炎的EUS标准包括高回声灶、高回声条索、小叶化、高回声导管、不规则导管、可见侧支、导管扩张、钙化和囊肿。

结果

126例患者接受了EUS和ERCP检查。根据存在的标准数量，EUS具有高度的灵敏度和特异度（>85%）。当存在超过两条标准（针对“所有慢性胰腺炎”）和超过六条标准（针对“中度至重度慢性胰腺炎”）时，慢性胰腺炎很可能存在（阳性预测值>85%）。当存在少于三条标准时，“中度至重度慢性胰腺炎”不太可能存在（阴性预测值>85%）。慢性胰腺炎的独立预测因素为“钙化”（p = 0.000001）、酗酒史（p = 0.002）和EUS标准总数（p = 0.008）。