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置入预防性临时3F胰管支架预防胆管插管困难患者内镜下逆行胰胆管造影术后胰腺炎:一项多中心、前瞻性随机

发布日期:2014-1-29 12:40:53 文章来源:ENDOSCOPY 作者次数:2546
    置入预防性临时3F胰管支架预防胆管插管困难患者内镜下逆行胰胆管造影术后胰腺炎:一项多中心、前瞻性随机研究

    背景

    内镜下逆行胰胆管造影术后胰腺炎(PEP)是内镜下逆行胰胆管造影术最常见且严重的并发症。困难性胆管插管成为操作相关的PEP风险因素。最近的研究报告,预防性胰管支架置入(PS)可降低PEP的发生频率和严重程度。

    目的

    评估以预防胆管插管困难的患者发生PEP而置入的临时3F 预防性胰管支架的有效性和实用性。

    设计

    一项多中心、前瞻性随机研究。

    环境

    两所三级学术医疗中心。

    患者
    101例胆管插管困难的患者被随机分为2组,即3F PS置入组(PS组,n = 50)或无支架组(NS组,n= 51)。

    干预

    内镜下置入3F 无凸缘胰管支架。

    主要测量指标

    两组PEP发生率和严重性,支架自发脱落,以及操作相关的并发症。

    结果

    3F PS置入组的技术成功率为96%48/50)。支架的长度分别为4 cmn = 21)、6 cm n = 15)和8 cmn = 12)。7天内94%45/48)的患者出现支架自发脱落。截止自发脱落的平均持续时间为3.5天。PSPEP的发生率为12%6/505例轻度;1例中度),NSPEP的发生率为29.4% 15/5112例轻度;2例中度;1例重度)。NS组中仅1例患者出现重度胰腺炎。多变量分析显示,预防性置入胰管支架是唯一的PEP 预防性因素(比值比为0.12695%置信区间为0.025-0.632P = 0.012)。

    局限性

    支架尺寸和直径无比较结果,低风险队列组。

    结论

    ERCP期间预防性临时3F PS 置入胆管插管困难的患者似乎是一种安全有效的降低PEP的方法,并可导致支架自发脱落发生率较高,而且无并发症

    缩写词NS,无支架;PD,胰管;PEPERCP术后胰腺炎;PS,胰管支架;SD,标准差;SOD,括约肌功能异常


     

    Prophylactic temporary 3F pancreatic duct stent to prevent post-ERCP pancreatitis in patients with a difficult biliary cannulation: a multicenter, prospective, randomized study

    Received 30 September 2011; accepted 1 May 2012. published online 09 July 2012.

    Background

    Post-ERCP pancreatitis (PEP) is the most common and serious complication of ERCP. Difficult biliary cannulation can be a procedure-related risk factor for PEP. Recent studies reported that a prophylactic pancreatic stent (PS) can reduce the frequency and severity of PEP.

    Objective

    To evaluate the efficacy and usefulness of a temporary 3F PS to prevent PEP in patients with difficult biliary cannulations.

    Design

    A multicenter, prospective, randomized study.

    Setting

    Two tertiary-care academic medical centers.

    Patients

    In total, 101 patients with a difficult biliary cannulation were randomly divided into the 3F PS placement group (PS group, n = 50) or the nonstent (NS) group (NS group, n = 51).

    Interventions

    Endoscopic placement of a 3F unflanged PS.

    Main Outcome Measurements

    The incidence and severity of PEP in the 2 groups, spontaneous dislodgment of stents, and procedure-related complications.

    Results

    The technical success rate of 3F PS placement was 96% (48/50). The lengths of the stents were 4 cm (n = 21), 6 cm (n = 15), and 8 cm (n = 12). Spontaneous stent dislodgment within 7 days occurred in 94% of patients (45/48). The mean duration until spontaneous dislodgment was 3.5 days. The incidence rate of PEP was 12% (6/50: mild, 5; moderate, 1) in the PS group and 29.4% (15/51: mild, 12; moderate, 2; severe, 1) in the NS group. Severe pancreatitis occurred in only 1 patient in the NS group. In a multivariate analysis, prophylactic placement of PS was the only prophylactic factor for PEP (odds ratio, 0.126; 95% CI, 0.025-0.632, P = .012).

    Limitations

    No comparative results for stent size and diameter and a low-risk cohort group.

    Conclusions

    Prophylactic temporary 3F PS placement in patients with a difficult biliary cannulation during ERCP seems to be a safe and effective method for reducing PEP and results in a high rate of spontaneous passage of stents without complications.

    Abbreviations:  NS, nonstent, PD, pancreatic duct, PEP, post-ERCP pancreatitis, PS, pancreatic stent, SD, standard deviation, SOD, sphincter of Oddi dysfunction

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