立即或按需的内镜内切除术用于瘤性胰腺炎:一项随机对照试验 (WONDER-01)
Tomotaka Saito1, Toshio Fujisawa2, Takeshi Ogura3
1Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Gastroenterology
|February 20, 2026
概括
在内镜超声波 (EUS) 引导排水后立即直接内镜内切除术 (DEN) 加快了瘤性胰腺炎患者的恢复速度. 这种方法提供更快的临床成功,而不会增加不良事件相比,一个步骤的战略.
科学领域:
- 胃肠病学 胃肠病学
- 干预性内镜检查是干预性的内镜检查.
- 胰腺疾病 胰腺疾病
背景情况:
- 死亡性胰腺炎需要及时干预.
- 以内镜超声波 (EUS) 为指导的外壁排水是关键的治疗方式.
- 直接内镜内切除术 (DEN) 排水后的最佳时间尚不清楚.
研究的目的:
- 为了比较立即的DEN与以排水为导向的逐步方法,用于症状性瘤性胰腺炎.
- 评估即时DEN及时对临床成功的影响.
主要方法:
- 一个多中心,开放标签,优越性随机试验 (WONDER-01).
- 患者接受了EUS指导排水,然后随机分配到即时DEN或逐步方法.
- 主要终点:临床成功的时间 (采集大小≤3厘米,改善炎症标志物).
主要成果:
- 立即DEN缩短了临床成功的时间 (中位数为29 vs 44天,P=.009).
- 两组之间不良事件的发生率相似 (24%对22%,P=.79).
- 技术成功率和死亡率没有显著差异.
结论:
- 在EUS引导排水后立即进行DEN可以加速临床成功的死亡性胰腺炎.
- 这种策略是安全的,不会增加不良结果.
- 与渐进式方法相比,即时DEN需要更多的死体切除手术.
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