|
超声内镜在特发性急性胰腺炎中的应用价值
|
Abstract:
特发性急性胰腺炎(Idiopathic acute pancreatitis, IAP)是指除外饮酒、滥用药物等因素后,结合患者病史、体格检查、实验室检查及影像学检查仍无法明确病因的急性胰腺炎(acute pancreatitis, AP)。与CT和MRI相比,超声内镜(Endoscopic ultrasound, EUS)探头离胰腺距离近,可清楚观察胰腺结构,可作为内镜下逆行胰胆管造影(endoscopic retrograde cholangiopancreatography, ERCP),及磁共振胰胆管造影(magnetic resonance cholangiopancreatography, MRCP)等影像学检查及血钙、血脂、抗核抗体和IgG4等实验室检查诊断失败时的一种重要诊断工具。EUS与ERCP相比其并发症发生率低。目前EUS已发展成为评估胰胆疾病及指导治疗的重要检查方式。本文指在探讨了EUS在IAP中的临床应用价值。
Idiopathic acute pancreatitis (Idiopathic acute pancreatitis, IAP) refers to acute pancreatitis (acute pancreatitis, AP) in which the etiology is still not clear in combination with patient history, physical examination, laboratory examination and imaging examination after excluding alcohol consumption, drug abuse and other factors. Compared with CT and MRI, endoscopic ultrasonography (Endoscopic ultrasound, EUS) probe is closer to the pancreas to clearly observe the structure of pancreas. It can be used as an important diagnostic tool for imaging examinations such as endoscopic retrograde cholangiopancreatography (endoscopic retrograde cholangiopancreatography, ERCP), magnetic resonance cholangiopancreatography (magnetic resonance cholangiopancreatography, MRCP) and laboratory tests such as serum calcium, blood lipids, antinuclear antibodies and IgG4 when the diagnosis fails. The incidence of complications in EUS is lower than that in ERCP. At present, EUS has developed into an important examination method to evaluate pancreaticobiliary diseases and guide treatment. This article discusses the clinical application value of EUS in IAP.
[1] | Del Vecchio Blanco, G., Gesuale, C., Varanese, M., Monteleone, G. and Paoluzi, O.A. (2019) Idiopathic Acute Pancreatitis: A Review on Etiology and Diagnostic Work-up. Clinical Journal of Gastroenterology, 12, 511-524. https://doi.org/10.1007/s12328-019-00987-7 |
[2] | Vila, J.J., Vicuña, M., Irisarri, R., Gonzalez de la Higuera, B., Ruiz-Clavijo, D., Rodríguez-Gutiérrez, C., et al. (2009) Diagnostic Yield and Reliability of Endoscopic Ultrasonography in Patients with Idiopathic Acute Pancreatitis. Scandinavian Journal of Gastroenterology, 45, 375-381. https://doi.org/10.3109/00365520903508894 |
[3] | Kinney, T.P., Lai, R. and Freeman, M.L. (2006) Endoscopic Approach to Acute Pancreatitis. Reviews in Gastroenterological Disorders, 6, 119-135. |
[4] | Yusoff, I.F., Raymond, G. and Sahai, A.V. (2004) A Prospective Comparison of the Yield of EUS in Primary vs. Recurrent Idiopathic Acute Pancreatitis. Gastrointestinal Endoscopy, 60, 673-678. https://doi.org/10.1016/s0016-5107(04)02018-8 |
[5] | Working Group IAP/APA Acute Pancreatitis Guidelines (2013) IAP/APA Evidence-Based Guidelines for the Management of Acute Pancreatitis. Pancreatology, 13, e1-e15. https://doi.org/10.1016/j.pan.2013.07.063 |
[6] | Tenner, S., Baillie, J., DeWitt, J. and Vege, S.S. (2013) American College of Gastroenterology Guideline: Management of Acute Pancreatitis. American Journal of Gastroenterology, 108, 1400-1415. https://doi.org/10.1038/ajg.2013.218 |
[7] | Lopes, C.V., Pereira-Lima, J. and Hartmann, A.A. (2019) The Role of Linear Endosonography for the Diagnosis of Acute Pancreatitis When Other Methods Failed. Clinics and Research in Hepatology and Gastroenterology, 43, 98-103. https://doi.org/10.1016/j.clinre.2018.08.004 |
[8] | Cornett, D.D., Spier, B.J., Eggert, A.A. and Pfau, P.R. (2011) The Causes and Outcome of Acute Pancreatitis Associated with Serum Lipase>10,000 U/L. Digestive Diseases and Sciences, 56, 3376-3381. https://doi.org/10.1007/s10620-011-1752-5 |
[9] | Ardengh, J.C., Malheiros, C.A., Rahal, F., Pereira, V. and Ganc, A.J. (2010) Microlithiasis of the Gallbladder: Role of Endoscopic Ultrasonography in Patients with Idiopathic Acute Pancreatitis. Revista da Associação Médica Brasileira, 56, 27-31. https://doi.org/10.1590/s0104-42302010000100011 |
[10] | Sharma, M. and Somani, P. (2018) EUS of Pancreatic Ascariasis. Arab Journal of Gastroenterology, 19, 47-48. https://doi.org/10.1016/j.ajg.2018.02.011 |
[11] | Barbu, S.T., Valeanu, D., Muresan, A., Munteanu, D. and Casoinic, F. (2018) Cystic Dystrophy of the Duodenal Wall in Heterotopic Pancreas with Groove Pancreatitis: A Diagnostic and Therapeutic Challenge. Chirurgia, 113, 418-423. https://doi.org/10.21614/chirurgia.113.3.418 |
[12] | Pereira, R., Eslick, G. and Cox, M. (2019) Endoscopic Ultrasound for Routine Assessment in Idiopathic Acute Pancreatitis. Journal of Gastrointestinal Surgery, 23, 1694-1700. https://doi.org/10.1007/s11605-019-04272-3 |
[13] | Umans, D.S., Rangkuti, C.K., Sperna Weiland, C.J., Timmerhuis, H.C., Bouwense, S.A.W., Fockens, P., et al. (2020) Endoscopic Ultrasonography Can Detect a Cause in the Majority of Patients with Idiopathic Acute Pancreatitis: A Systematic Review and Meta-Analysis. Endoscopy, 52, 955-964. https://doi.org/10.1055/a-1183-3370 |
[14] | Mitra, T., Dixit, V.K., Yadav, D.P., Shukla, S.K., Verma, A., Thakur, P., et al. (2021) Idiopathic Acute Pancreatitis—A Myth or Reality? Role of Endoscopic Ultrasonography and Magnetic Resonance Cholangiopancreatography in Its Diagnosis. Indian Journal of Gastroenterology, 40, 22-29. https://doi.org/10.1007/s12664-020-01125-9 |
[15] | Levy, M.J. (2002) The Hunt for Microlithiasis in Idiopathic Acute Recurrent Pancreatitis: Should We Abandon the Search or Intensify Our Efforts? Gastrointestinal Endoscopy, 55, 286-293. https://doi.org/10.1067/mge.2002.121224 |
[16] | Rashdan, A., Fogel, E., McHenry, L., Lehman, G. and Sherman, S. (2003) Frequency of Biliary Crystals in Patients with Suspected Sphincter of Oddi Dysfunction. Gastrointestinal Endoscopy, 58, 875-878. https://doi.org/10.1016/s0016-5107(03)02311-3 |
[17] | Mirbagheri, S.A., Mohamadnejad, M., Nasiri, J., Vahid, A.A., Ghadimi, R. and Malekzadeh, R. (2005) Prospective Evaluation of Endoscopic Ultrasonography in the Diagnosis of Biliary Microlithiasis in Patients with Normal Transabdominal Ultrasonography. Journal of Gastrointestinal Surgery, 9, 961-964. https://doi.org/10.1016/j.gassur.2005.03.002 |
[18] | Kaw, M. and Brodmerkel, G.J. (2002) ERCP, Biliary Crystal Analysis, and Sphincter of Oddi Manometry in Idiopathic Recurrent Pancreatitis. Gastrointestinal Endoscopy, 55, 157-162. https://doi.org/10.1067/mge.2002.118944 |
[19] | Ros, E., Navarro, S., Bru, C., Garcia-Pugés, A. and Valderrama, R. (1991) Occult Microlithiasis in ‘Idiopathic’ Acute Pancreatitis: Prevention of Relapses by Cholecystectomy or Ursodeoxycholic Acid Therapy. Gastroenterology, 101, 1701-1709. https://doi.org/10.1016/0016-5085(91)90410-m |
[20] | Venu, R.P., Geenen, J.E., Hogan, W., Stone, J., Johnson, G.K. and Soergel, K. (1989) Idiopathic Recurrent Pancreatitis. Digestive Diseases and Sciences, 34, 56-60. https://doi.org/10.1007/bf01536154 |
[21] | Liu, C., Lo, C., Chan, J.K.F., Poon, R.T.P. and Fan, S. (2000) EUS for Detection of Occult Cholelithiasis in Patients with Idiopathic Pancreatitis. Gastrointestinal Endoscopy, 51, 28-32. https://doi.org/10.1016/s0016-5107(00)70382-8 |
[22] | Verma, D., Kapadia, A., Eisen, G.M. and Adler, D.G. (2006) EUS vs MRCP for Detection of Choledocholithiasis. Gastrointestinal Endoscopy, 64, 248-254. https://doi.org/10.1016/j.gie.2005.12.038 |
[23] | Liu, C., Lo, C., Chan, J.K., Poon, R.T., Lam, C., Fan, S., et al. (2001) Detection of Choledocholithiasis by EUS in Acute Pancreatitis: A Prospective Evaluation in 100 Consecutive Patients. Gastrointestinal Endoscopy, 54, 325-330. https://doi.org/10.1067/mge.2001.117513 |
[24] | Said, M. and Rongen, A.P.M. (2017) Can Laparoscopic Cholecystectomy Prevent Recurrent Idiopathic Acute Pancreatitis? Annals of Surgery, 266, e94-e95. https://doi.org/10.1097/sla.0000000000001748 |
[25] | Stevens, C.L., Abbas, S.M. and Watters, D.A.K. (2016) How Does Cholecystectomy Influence Recurrence of Idiopathic Acute Pancreatitis? Journal of Gastrointestinal Surgery, 20, 1997-2001. https://doi.org/10.1007/s11605-016-3269-x |
[26] | Moolla, Z., Anderson, F. and Thomson, S.R. (2012) Use of Amylase and Alanine Transaminase to Predict Acute Gallstone Pancreatitis in a Population with High HIV Prevalence. World Journal of Surgery, 37, 156-161. https://doi.org/10.1007/s00268-012-1801-z |
[27] | Ammori, B.J., Boreham, B., Lewis, P. and Roberts, S.A. (2003) The Biochemical Detection of Biliary Etiology of Acute Pancreatitis on Admission: A Revisit in the Modern Era of Biliary Imaging. Pancreas, 26, e32-e35. https://doi.org/10.1097/00006676-200303000-00023 |
[28] | Wilcox, M.C., Seay, T., Kim, H. and Varadarajulu, S. (2016) Prospective Endoscopic Ultrasound-Based Approach to the Evaluation of Idiopathic Pancreatitis: Causes, Response to Therapy, and Long-Term Outcome. American Journal of Gastroenterology, 111, 1339-1348. https://doi.org/10.1038/ajg.2016.240 |
[29] | Vila, J.J., Mendioroz, F.J.J., Yeaton, P., Fernández-Urién, I., Sanchotena, J.L.G., Goñi, S., et al. (2020) EUS Is Superior to Secretin-Enhanced Cholangio-MRI to Establish the Etiology of Idiopathic Acute Pancreatitis. Endoscopy International Open, 8, E1441-E1447. https://doi.org/10.1055/a-1233-1849 |
[30] | Kim, D.B., Paik, C., Song, D.S., Kim, H.A., Kim, Y., Lee, J.M., et al. (2018) The Role of Endoscopic Ultrasonography and Magnetic Resonance Cholangiopancreatography in Patients with Acute Pancreatitis after Negative Computed Tomography Findings of the Etiology. Pancreas, 47, 1165-1171. https://doi.org/10.1097/mpa.0000000000001149 |
[31] | Rana, S.S. (2022) Evaluating the Role of Endoscopic Ultrasound in Pancreatitis. Expert Review of Gastroenterology & Hepatology, 16, 953-965. https://doi.org/10.1080/17474124.2022.2138856 |
[32] | Valverde-López, F., Ortega-Suazo, E.J., Wilcox, C.M., Fernandez-Cano, M.C., Martínez-Cara, J.G. and Redondo-Cerezo, E. (2020) Endoscopic Ultrasound as a Diagnostic and Predictive Tool in Idiopathic Acute Pancreatitis. Annals of Gastroenterology, 33, 1-8. https://doi.org/10.20524/aog.2020.0464 |
[33] | Kadyada, S.P., Thapa, B.R., Dhaka, N., Bhatia, A. and Menon, J. (2019) Role of Diagnostic Endoscopic Ultrasound in Idiopathic Acute Pancreatitis and Acute Recurrent Pancreatitis in Children. Pancreas, 48, 350-355. https://doi.org/10.1097/mpa.0000000000001243 |
[34] | Riff, B.P. and Chandrasekhara, V. (2016) The Role of Endoscopic Retrograde Cholangiopancreatography in Management of Pancreatic Diseases. Gastroenterology Clinics of North America, 45, 45-65. https://doi.org/10.1016/j.gtc.2015.10.009 |
[35] | Brandstätter, G., Schinzel, S. and Wurzer, H. (1996) Influence of Spasmolytic Analgesics on Motility of Sphincter of Oddi. Digestive Diseases and Sciences, 41, 1814-1818. https://doi.org/10.1007/bf02088751 |
[36] | Dhar, A., Goenka, M.K., Kochhar, R., et al. (1996) Pancrease Divisum: Five Years’ Experience in a Teaching Hospital. Indian Journal of Gastroenterology, 15, 7-9. |
[37] | Bhutani, M.S., Hoffmann, B.J. and Hawes, R.H. (1999) Diagnosis of Pancreas Divisum by Endoscopic Ultrasonography. Endoscopy, 31, 167-169. https://doi.org/10.1055/s-1999-14120 |
[38] | Lai, R., Freeman, M.L., Cass, O.W. and Mallery, S. (2004) Accurate Diagnosis of Pancreas Divisum by Linear-Array Endoscopic Ultrasonography. Endoscopy, 36, 705-709. https://doi.org/10.1055/s-2004-825663 |
[39] | Tepox-Padrón, A., Bernal-Mendez, R.A., Duarte-Medrano, G., Romano-Munive, A.F., Mairena-Valle, M., Ramírez-Luna, M.Á., et al. (2021) Utility of Endoscopic Ultrasound in Idiopathic Acute Recurrent Pancreatitis. BMJ Open Gastroenterology, 8, e000538. https://doi.org/10.1136/bmjgast-2020-000538 |
[40] | Hallensleben, N.D., Umans, D.S., Bouwense, S.A., Verdonk, R.C., Romkens, T.E., Witteman, B.J., et al. (2020) The Diagnostic Work‐up and Outcomes of ‘Presumed’ Idiopathic Acute Pancreatitis: A Post‐Hoc Analysis of a Multicentre Observational Cohort. United European Gastroenterology Journal, 8, 340-350. https://doi.org/10.1177/2050640619890462 |
[41] | Bartell, N., Bittner, K., Vetter, M.S., Kothari, T., Kaul, V. and Kothari, S. (2019) Role of Endoscopic Ultrasound in Detecting Pancreatic Cancer Missed on Cross-Sectional Imaging in Patients Presenting with Pancreatitis: A Retrospective Review. Digestive Diseases and Sciences, 64, 3623-3629. https://doi.org/10.1007/s10620-019-05807-z |
[42] | Perugino, C.A. and Stone, J.H. (2020) IgG4-Related Disease: An Update on Pathophysiology and Implications for Clinical Care. Nature Reviews Rheumatology, 16, 702-714. https://doi.org/10.1038/s41584-020-0500-7 |
[43] | Okamoto, A., Watanabe, T., Kamata, K., Minaga, K. and Kudo, M. (2019) Recent Updates on the Relationship between Cancer and Autoimmune Pancreatitis. Internal Medicine, 58, 1533-1539. https://doi.org/10.2169/internalmedicine.2210-18 |
[44] | Peery, A.F., Crockett, S.D., Murphy, C.C., Lund, J.L., Dellon, E.S., Williams, J.L., Jensen, E.T., et al. (2019) Burden and Cost of Gastrointestinal, Liver, and Pancreatic Diseases in the United States: Update 2018. Gastroenterology, 156, 254-272.E11. https://doi.org/10.1053/j.gastro.2018.08.063 |