困难的胆管管道对ERCP后胰腺炎的影响:支架与印梅他辛试验数据集对支架的二次分析
Samuel Han1, Jingwen Zhang2, Valerie Durkalski-Mauldin2
1Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
Gastrointestinal endoscopy
|October 10, 2024
概括
困难的胆管管道 (DBC) 显著增加ERCP后胰腺炎 (PEP) 的风险,特别是当与先前存在的风险因素相结合时. 胰腺管道的线路通道是一个关键的风险,但用印米他素预防性胰腺管道支架有效地减轻了这种风险.
科学领域:
- 胃肠病学 胃肠病学
- 内镜逆行胆瘤胆瘤学 (ERCP) 是一种内镜.
- 胰腺炎研究研究
背景情况:
- 困难的胆管通道 (DBC) 是ERCP后胰腺炎 (PEP) 的已知的危险因素.
- 了解导致DBC中PEP的特定技术因素对于降低风险至关重要.
- 本研究研究了DBC技术细节与已确定的PEP风险因素之间的相互作用.
研究的目的:
- 分析DBC的技术方面如何影响发展PEP的风险.
- 在DBC期间识别与增加PEP发病率相关的特定程序元素.
- 评估预防性胰腺管支架在高风险患者接受DBC的PEP预防中与印米他辛联合使用的胰腺管支架的疗效.
主要方法:
- 一个多中心随机对照试验的二次分析,比较直肠印梅他辛与印梅他辛加上预防性胰腺管道 (PD) 支架放置.
- 患者被分为三组:具有高PEP前风险的DBC,没有高PEP前风险的DBC和具有高PEP前风险的非DBC.
- 统计分析的重点是确定程序变量与PEP发展之间的关联.
主要成果:
- 在84.1%的参与者中,发生了困难的胆管管道 (DBC),平均12次尝试和14.7分钟.
- 在具有高预PEP风险的DBC (20.7%),其次是具有高预PEP风险的非DBC (13.5%) 和没有高预PEP风险的DBC (8.8%) 中观察到的PEP率最高.
- 胰腺管 (PD) 导线通道的增加 (aOR,1.97) 与DBC中的PEP有显著的关联;然而,PD注射,胰腺缩切除术和管试验数量并非如此. 结合印梅他辛与PD支架放置,在DBC中降低了PEP风险 (aOR,0.61),即使有多达4个PD线路通道.
结论:
- 困难的胆管通道 (DBC) 增加了ERCP后胰腺炎 (PEP) 的预先存在的风险因素.
- 在DBC期间胰腺管道的线路通道是增加PEP风险的主要驱动因素.
- 预防性胰腺管道支架结合印米他素有效降低了PEP在DBC的风险,即使有多个PD线路通道.
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