Endoscopic Interventions for the Early and Remission Phases of Acute Biliary Pancreatitis: What are the More Concrete and Practical Situations for Performing Them?
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Background/Aims: The use of endoscopic intervention (EI) for acute biliary pancreatitis (ABP) remains controversial because theseverity of biliary obstruction/cholangitis/pancreatitis is not reflected in the indications for early EI (EEI). Methods: A total of 148 patients with ABP were included to investigate 1) the differences in the rate of worsening cholangitis/pancreatitis between the EEI group and the early conservative management (ECM) group, especially for each severity of cholangitis/pancreatitis, and 2) the diagnostic ability of imaging studies, including endoscopic ultrasound (EUS), to detect common bile ductstones (CBDSs) in the ECM group. Results: No differences were observed in the rate of worsening cholangitis between the EEI and ECM groups, regardless of theseverity of cholangitis and/or the existence of impacted CBDSs. Among patients without impacted CBDSs and moderate/severecholangitis, worsening pancreatitis was significantly more frequent in the EEI group (18% vs. 4%, p=0.048). In patients in the ECMgroup, the sensitivity and specificity for detecting CBDSs were 73% and 98%, respectively, for EUS, whereas the values were 13% and92%, respectively, for magnetic resonance cholangiopancreatography. Conclusions: EEI should be avoided in the absence of moderate/severe cholangitis and/or impacted CBDSs because of the high rateof worsening pancreatitis. EUS can contribute to the accurate detection of residual CBDSs, for the determination of the need forelective EI.
Abstract
Background/Aims: The use of endoscopic intervention (EI) for acute biliary pancreatitis (ABP) remains controversial because theseverity of biliary obstruction/cholangitis/pancreatitis is not reflected in the indications for early EI (EEI). Methods: A total of 148 patients with ABP were included to investigate 1) the differences in the rate of worsening cholangitis/pancreatitis between the EEI group and the early conservative management (ECM) group, especially for each severity of cholangitis/pancreatitis, and 2) the diagnostic ability of imaging studies, including endoscopic ultrasound (EUS), to detect common bile ductstones (CBDSs) in the ECM group. Results: No differences were observed in the rate of worsening cholangitis between the EEI and ECM groups, regardless of theseverity of cholangitis and/or the existence of impacted CBDSs. Among patients without impacted CBDSs and moderate/severecholangitis, worsening pancreatitis was significantly more frequent in the EEI group (18% vs. 4%, p=0.048). In patients in the ECMgroup, the sensitivity and specificity for detecting CBDSs were 73% and 98%, respectively, for EUS, whereas the values were 13% and92%, respectively, for magnetic resonance cholangiopancreatography. Conclusions: EEI should be avoided in the absence of moderate/severe cholangitis and/or impacted CBDSs because of the high rateof worsening pancreatitis. EUS can contribute to the accurate detection of residual CBDSs, for the determination of the need forelective EI.
참고문헌 (20)
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