在ASGE高风险群体中,内镜超声波避免了诊断ERCP - - 亚洲人口中的经验
Weng-Fai Wong1, Yu-Ting Kuo2, Ming-Lun Han2
1Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, Taipei, Taiwan.
Journal of the Formosan Medical Association = Taiwan yi zhi
|September 6, 2023
概括
对常见胆道结石的修订后的ASGE标准在亚洲患者中显示出较低的准确性. 对于高危人群,建议在直接ERCP之前进行内镜超声波 (EUS),以避免不必要的手术.
科学领域:
- 胃肠病学 胃肠病学
- 医学诊断 医学诊断 医学诊断
- 临床内镜检查 临床内镜检查
背景情况:
- 美国胃肠内镜学会 (ASGE) 在2010年开发了一种常见胆道结石 (CBD) 的预测系统,并在2019年进行了修订.
- 该系统在亚洲人群中的适用性,具有明显的胆管结石病因和医疗保健准入,需要研究.
研究的目的:
- 评估修订后的ASGE标准的准确性,以预测亚洲人群中常见的胆道结石.
- 根据这些标准,确定内镜超声波 (EUS) 的有用性.
主要方法:
- 一项回顾性单中心研究收集了142名患者的数据,这些患者在10年内因疑似CBD石头而接受了EUS.
- 修订后的ASGE标准的准确性与EUS结果进行了评估,对虚假阴性结果进行了至少6个月的随访.
主要成果:
- 在142名患者中,87人 (61%) 患有CBD结石. 修订后的ASGE标准在高风险患者中显示精度低 (57%).
- 在ASGE定义的高风险患者中,36%的人对EUS上的CBD石头呈阴性. CBD扩张和上升性胆管炎是显著的预测因素.
结论:
- 该研究发现,当仅依赖标准时,ASGE定义的高风险患者中虚假阴性率很高 (36%).
- 建议使用内镜超声波 (EUS) 作为亚洲社会选择性高风险患者的初步诊断工具,以防止不必要的直接ERCP.
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