Prospective, randomized, controlled trial of prophylactic pancreatic stent placement for endoscopic snare excision of the duodenal ampulla
Prospective, randomized, controlled trial of prophylactic pancreatic stent placement for endoscopic snare excision of the duodenal ampulla
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DOI：
10.1016/j.gie.2005.04.020
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发表时间：
2005-09-01
影响因子：
7.7
通讯作者：
Gostout, CJ
中科院分区：
文献类型：
--
作者：
Harewood, GC;Pochron, NL;Gostout, CJ
背景资料：发生在十二指肠乳头的肿瘤占胃肠道肿瘤的5%，占可切除的胰十二指肠肿瘤的36%。关于内镜下乳头切除术安全性的已发表文献有限。虽然对预防性胰管支架置入有共识，但支持性前瞻性数据很少。本随机对照试验的目的是比较没有/没有接受预防性胰管支架置入术的患者的圈套壶腹切除术后胰腺炎的发生率。Methods：将接受整块圈套壶腹切除术的患者随机分为壶腹切除术后放置胰管支架组和不放置支架组。术后24 h内发生胰腺炎3例，均发生在未置入支架组，发生率为33%，置入支架组为0%，P = 0.02。中位峰值淀粉酶水平为3692 U/L（范围1819-4700 U/L），中位峰值脂肪酶水平为11450 U/L（范围5900- 17，000 U/L）。所有3例患者住院中位数为2粘土（范围1-6），并都取得了完全recovery.Conclusions：我们的研究结果表明，胰腺支架置入术在减少壶腹切除术后胰腺炎的保护作用。未来的大规模研究需要证实这种益处。
Background: Tumors that arise in the region of the major duodenal papilla account for 5% of GI neoplasms and 36% of resectable pancreaticoduodenal tumors. There is limited published literature that addresses the safety of endoscopic excision of the papilla. Although there is consensus about prophylactic pancreatic-duct stent placement, there is little supporting prospective data. The aim of this randomized, controlled trial was to compare the rates of postsnare ampullectomy pancreatitis in patients who did/did not receive prophylactic pancreatic-duct stent placement.Methods: Consecutive patients who were to undergo en bloc snare ampullectomy were randomized to placement of pancreatic-duct stent after ampullectomy or to no stent placement.Results: In total, 19 patients were enrolled, and 10 received pancreatic stents. Postprocedure pancreatitis occurred in 3 patients in the 24 hours after endoscopy, all cases Occurred in the unstented group, 33% vs. 0% (stented group), P = 0.02. Median peak amylase level was 3692 U/L (range 1819-4700 U/L) and median peak lipase level was 11450 U/L (range 5900-17,000 U/L). All 3 patients were hospitalized for a median of 2 clays (range 1-6), and all made a complete recovery.Conclusions: Our findings suggest that a protective effect is conferred by pancreatic stent placement in reducing postampullectomy pancreatitis. Future large-scale studies are required to confirm this benefit.