对ERCP后胰腺炎的临床实践指南2023年
Shuntaro Mukai1, Yoshifumi Takeyama2, Takao Itoi1
1Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
概括
更新的临床实践指南提供了基于证据的预防,诊断和管理ERCP后胰腺炎 (PEP) 的策略. 关键建议包括胰腺管支架和NSAIDs,以减少ERCP患者的PEP发生率.
科学领域:
- 胃肠病学 胃肠病学
- 临床实践指南 临床实践指南
- 胰腺学 胰腺学
背景情况:
- 在ERCP后的胰腺炎 (PEP) 是内镜逆行胆血管瘤学 (ERCP) 最常见的并发症.
- 自2015年以来,ERCP技术的进步和新的研究需要更新指南.
- 这些指导方针重点关注接受ERCP的成年患者.
研究的目的:
- 为PEP预防,诊断和管理提供最新的,基于证据的建议.
- 为临床医生建立一个全面的框架,以尽量减少PEP风险.
- 在制定指导方针时采用GRADE方法.
主要方法:
- 用GRADE方法来评估证据和制定指导方针.
- 审查了PEP的程序和患者相关的风险因素.
- 综合了关于PEP的诊断标准和治疗方案的当前研究.
主要成果:
- 建议对高风险患者进行内镜超声波,以避免不必要的ERCP程序.
- 强调在影响PEP率方面,运营商的经验不如熟练的监督那么重要.
- 建议监测血清胰腺酶水平和早期CT扫描以进行诊断.
- 建议标准的急性胰腺炎治疗方案.
- 强烈支持临时胰腺管支架和直肠NSAIDs用于PEP预防.
结论:
- 2023年准则为减少PEP发病率和改善患者治疗结果提供了一个强有力的框架.
- 基于证据的预防措施,如胰腺支架和NSAIDs至关重要.
- 遵守最新的诊断和管理策略对于临床实践至关重要.
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