Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline
Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline
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DOI：
10.1055/s-0032-1309840
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发表时间：
2012-08-01
期刊：
影响因子：
9.3
通讯作者：
Bruno, M.
中科院分区：
文献类型：
--
作者：
Dumonceau, J-M.;Delhaye, M.;Bruno, M.
背景和目标：澄清欧洲胃肠内镜学会（ESGE）关于治疗慢性pancreatitis.Methods患者的介入治疗选择的立场：系统的文献检索，以回答明确的关键问题，证据水平，以确定推荐等级。ESGE资助了指南的制定。选择的诊断总结对于治疗疼痛性无并发症的慢性胰腺炎，ESGE建议将体外冲击波碎石术/内镜逆行胰胆管造影术作为一线介入选择。应在6 - 8周时评估临床反应;如果不满意，应在多学科团队中再次讨论患者的病例。应考虑手术选择，特别是在内镜治疗后预期结局较差的患者中（推荐等级B）。对于与阻塞主胰管的不透射线结石>= 5 mm相关的慢性胰腺炎，ESGE建议将体外冲击波碎石术作为第一步，根据中心的专业知识结合或不结合内镜取出结石碎片（推荐等级B）。为了治疗与主要胰管狭窄相关的慢性胰腺炎，ESGE建议插入单个10 Fr塑料支架，计划在1年内更换支架（建议等级C）。对于单次塑料支架植入12个月后持续存在导管狭窄的患者，ESGE建议使用可用的选择（例如。例如，在一个实施例中，内镜下放置多个胰腺支架，手术）在多学科团队中进行讨论对于内镜下可触及的无并发症的慢性胰腺假性囊肿，ESGE建议将内镜引流作为一线治疗（推荐A级）。对于治疗慢性胰腺炎相关的胆管狭窄，内镜和外科治疗的选择应依赖于当地的专业知识，患者合并症和预期患者对重复内镜手术的依从性（推荐等级D）。如果选择内镜检查，ESGE建议临时放置多个并排塑料胆道支架（建议A级）。
Background and aims: Clarification of the position of the European Society of Gastrointestinal Endoscopy (ESGE) regarding the interventional options available for treating patients with chronic pancreatitis.Methods: Systematic literature search to answer explicit key questions with levels of evidence serving to determine recommendation grades. The ESGE funded development of the Guideline.Summary of selected recommendationsFor treating painful uncomplicated chronic pancreatitis, the ESGE recommends extracorporeal shockwave lithotripsy/endoscopic retrograde cholangiopancreatography as the first-line interventional option. The clinical response should be evaluated at 6 - 8 weeks; if it appears unsatisfactory, the patient's case should be discussed again in a multidisciplinary team. Surgical options should be considered, in particular in patients with a predicted poor outcome following endoscopic therapy (Recommendation grade B). For treating chronic pancreatitis associated with radiopaque stones >= 5mm that obstruct the main pancreatic duct, the ESGE recommends extracorporeal shockwave lithotripsy as a first step, combined or not with endoscopic extraction of stone fragments depending on the expertise of the center (Recommendation grade B).For treating chronic pancreatitis associated with a dominant stricture of the main pancreatic duct, the ESGE recommends inserting a single 10-Fr plastic stent, with stent exchange planned within 1 year (Recommendation grade C). In patients with ductal strictures persisting after 12 months of single plastic stenting, the ESGE recommends that available options (e. g., endoscopic placement of multiple pancreatic stents, surgery) be discussed in a multidisciplinary team (Recommendation grade D).For treating uncomplicated chronic pancreatic pseudocysts that are within endoscopic reach, the ESGE recommends endoscopic drainage as a first-line therapy (Recommendation grade A).For treating chronic pancreatitis-related biliary strictures, the choice between endoscopic and surgical therapy should rely on local expertise, patient co-morbidities and expected patient compliance with repeat endoscopic procedures (Recommendation grade D). If endoscopy is elected, the ESGE recommends temporary placement of multiple, side-by-side, plastic biliary stents (Recommendation grade A).