Endoscopic Intervention through Endoscopic Retrograde Cholangiopancreatography in the Management of Symptomatic Pancreas Divisum: A Long-Term Follow-Up Study
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Background/Aims: To evaluate the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) for the treatment of symptomatic pancreas divisum (PD) and to discuss whether ERCP procedures and outcomes in younger patients differ from those of adults. Methods: Symptomatic patients with PD were included in the study and divided into underaged (age ≤17 years) and adult (age ≥18 years) group. The clinical information of each patient was reviewed, and then the patients were contacted by telephone or their medical records were reviewed to determine their long-term followup outcomes. Results: A total of 141 procedures were performed in 82 patients (17 underaged and 65 adult patients). The ERCP indications included abdominal pain (39.02%), pancreatitis (12.20%), recurrent pancreatitis (36.59%), and other discomfort (12.20%). The endoscopic interventions included endoscopic pancreatic sphincterotomy in 44.68% of the patients, bouginage in 26.95%, pancreatic ductal stone extraction in 19.15%, endoscopic nasopancreatic drainage in 21.99%, and endoscopic retrograde pancreatic drainage in 56.74%. After a median follow-up of 41 months, the overall response rate was 62.32%. Between the underaged group and the adult group, significant differences were not observed in the ERCP procedures, complications and longterm follow-up results. Conclusions: ERCP is a safe and effective treatment for symptomatic PD. Based on the details, complications, and follow-up results, the ERCP procedure did not present differences between the underaged and adult groups.
Abstract
Background/Aims: To evaluate the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) for the treatment of symptomatic pancreas divisum (PD) and to discuss whether ERCP procedures and outcomes in younger patients differ from those of adults. Methods: Symptomatic patients with PD were included in the study and divided into underaged (age ≤17 years) and adult (age ≥18 years) group. The clinical information of each patient was reviewed, and then the patients were contacted by telephone or their medical records were reviewed to determine their long-term followup outcomes. Results: A total of 141 procedures were performed in 82 patients (17 underaged and 65 adult patients). The ERCP indications included abdominal pain (39.02%), pancreatitis (12.20%), recurrent pancreatitis (36.59%), and other discomfort (12.20%). The endoscopic interventions included endoscopic pancreatic sphincterotomy in 44.68% of the patients, bouginage in 26.95%, pancreatic ductal stone extraction in 19.15%, endoscopic nasopancreatic drainage in 21.99%, and endoscopic retrograde pancreatic drainage in 56.74%. After a median follow-up of 41 months, the overall response rate was 62.32%. Between the underaged group and the adult group, significant differences were not observed in the ERCP procedures, complications and longterm follow-up results. Conclusions: ERCP is a safe and effective treatment for symptomatic PD. Based on the details, complications, and follow-up results, the ERCP procedure did not present differences between the underaged and adult groups.
참고문헌 (27)
- Kin T, "Pancreas divisum: a study of the cadaveric donor pancreas for islet isolation", Pancreas, 30, pp.325~327 (2005)
- Alempijevic T, "Anatomical features of the minor duodenal papilla in pancreas divisum", Surg Radiol Anat, 28, pp.620~624 (2006)
- Brugge WR, "Endoscopic approach to the diagnosis and treatment of pancreatic disease", Curr Opin Gastroenterol, 29, pp.559~565 (2013)
- Klein SD, "Pancreas divisum, an evidence-based review:part I, pathophysiology", Gastrointest Endosc, 60, pp.419~425 (2004)
- Khalid A, "Approach to idiopathic recurrent pancreatitis", Gastrointest Endosc Clin N Am, 13, pp.695~716 (2003)
- Cotton PB, "Endoscopic sphincterotomy complications and their management: an attempt at consensus", Gastrointest Endosc, 37, pp.383~393 (1991)
- Cotton PB, "Outcomes of endoscopy procedures: struggling towards definitions", Gastrointest Endosc, 40, pp.514~518 (1994)
- Kamisawa T, "Clinical significance of the minor duodenal papilla and accessory pancreatic duct", J Gastroenterol, 39, pp.605~615 (2004)
- Cohen SA, "Pancreas divisum: endoscopic therapy", Surg Clin North Am, 81, pp.467~477 (2001)
- Kozu T, "Pancreatic development and anatomical variation", Gastrointest Endosc Clin N Am, 5, pp.1~30 (1995)
- Rustagi T, "Diagnosis and therapy of pancreas divisum by ERCP: a single center experience", J Dig Dis, 14, pp.93~99 (2013)
- Chacko LN, "Clinical outcomes and nonendoscopic interventions after minor papilla endotherapy in patients with symptomatic pancreas divisum", Gastrointest Endosc, 68, pp.667~673 (2008)
- Santi L, "First case of 2intraductal papillary mucinous tumors of both ventral and dorsal ducts in pancreas divisum", Pancreas, 39, pp.110~111 (2010)
- Kamisawa T, "Pancreas divisum in pancreaticobiliary maljunction", Hepatogastroenterology, 55, pp.249~253 (2008)
- Nakamura Y, "Adenoma of the minor papilla associated with pancreas divisum", Hepatogastroenterology, 54, pp.1841~1843 (2007)
- Takuma K, "Pancreatic diseases associated with pancreas divisum", Dig Surg, 27, pp.144~148 (2010)
- Tandan M, "Endotherapy in chronic pancreatitis", World J Gastroenterol, 19, pp.6156~6164 (2013)
- Yamamoto N, "Endoscopic minor papilla balloon dilation for the treatment of symptomatic pancreas divisum", Pancreas, 43, pp.927~930 (2014)
- Lu Y, "Short-term and long-term outcomes after endoscopic sphincterotomy versus endoscopic papillary balloon dilation for bile duct stones", Eur J Gastroenterol Hepatol, 26, pp.1367~1373 (2014)
- Wong LL, "Prevention of post-ERCP pancreatitis", World J Gastrointest Pathophysiol, 5, pp.1~10 (2014)
- Chen JJ, "Risk factors for post-ERCP pancreatitis:a systematic review of clinical trials with a large sample size in the past 10 years", Eur J Med Res, 19, pp.26~ (2014)
- Liao Z, "A systematic review on endoscopic detection rate, endotherapy, and surgery for pancreas divisum", Endoscopy, 41, pp.439~444 (2009)
- Kanth R, "Endotherapy in symptomatic pancreas divisum: a systematic review", Pancreatology, 14, pp.244~250 (2014)
- Agarwal J, "ERCP in the management of pancreatic diseases in children", Gastrointest Endosc, 79, pp.271~278 (2014)
- Borak GD, "Long-term clinical outcomes after endoscopic minor papilla therapy in symptomatic patients with pancreas divisum", Pancreas, 38, pp.903~906 (2009)
- Lans JI, "Endoscopic therapy in patients with pancreas divisum and acute pancreatitis: a prospective, randomized, controlled clinical trial", Gastrointest Endosc, 38, pp.430~434 (1992)
- Ahmed F, "Minor papilla endotherapy in patients with symptomatic pancreas divisum", Gastrointest Endosc, 68, pp.674~675 (2008)
