EUS pancreatic function testing and dynamic pancreatic duct evaluation for the diagnosis of exocrine pancreatic insufficiency and chronic pancreatitis.
EUS pancreatic function testing and dynamic pancreatic duct evaluation for the diagnosis of exocrine pancreatic insufficiency and chronic pancreatitis.
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EUS胰腺功能测试和动态胰管评估，用于诊断外分泌胰腺功能不全和慢性胰腺炎。
DOI：
10.1016/j.gie.2020.06.029
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发表时间：
2021-03
影响因子：
7.7
通讯作者：
Gardner TB
中科院分区：
文献类型：
--
作者：
DeWitt JM;Al-Haddad MA;Easler JJ;Sherman S;Slaven J;Gardner TB
EUS和内镜胰腺功能检查（ePFT）可用于诊断微小病变慢性胰腺炎（MCCP）。评价胰腺外分泌功能不全（EPI）和实时评估静脉注射促胰液素后EUS变化对MCCP临床诊断的影响尚不清楚。对疑似MCCP的患者进行胰腺实质的基线EUS评估，并测量头部、身体和尾部的主胰管（B-MPD）。静脉注射人促胰液素0.2 μg/kg，然后在4、8和12分钟后重复测量MPD（S-MPD）。在15、30和45分钟时抽吸十二指肠样本以评估碳酸氢盐浓度。内窥镜医师对慢性胰腺炎的临床可能性百分比进行评级（1）促胰液素前;（2）促胰液素后但在抽吸前;（3）碳酸氢盐结果后。共有145名连续患者（平均年龄，44±13岁; 98名女性）被诊断为EPI（n = 32; 22%）或胰腺外分泌功能正常（n = 131，78%）。分泌素后4和8分钟，外分泌功能正常组的尾部S-MPD/B-MPD比值较高。两组之间其他时间、位置和十二指肠液量的比值相似。在所有组中，促胰液素治疗后，慢性胰腺炎的中位百分比可能性发生统计学显著变化。EPI对EUS诊断慢性胰腺炎（≥5项标准）的敏感性和特异性分别为23.4%（95%可信区间，12.3-38.0）和78.6%（95%可信区间，69.1-86.2）。实时EUS结果和ePFT对MCCP的临床评估有重要影响。EPI诊断与EUS诊断MCCP相关性较差。（临床试验注册号：NCT 01997476。）
EUS and endoscopic pancreatic function tests (ePFTs) may be used to diagnose minimal-change chronic pancreatitis (MCCP). The impact of evaluation for exocrine pancreatic insufficiency (EPI) and real-time assessment of EUS changes after intravenous secretin on the clinical diagnosis of MCCP is unknown. Patients with suspected MCCP underwent baseline EUS assessment of the pancreatic parenchyma and measurement of the main pancreatic duct (B-MPD) in the head, body, and tail. Human secretin 0.2 μg/kg was given intravenously followed 4, 8, and 12 minutes later by repeat MPD (S-MPD) measurements. Duodenal samples at 15, 30, and 45 minutes were aspirated to assess bicarbonate concentration. Endoscopists rated the percentage clinical likelihood of chronic pancreatitis (1) before secretin; (2) after secretin but before aspiration; and (3) after bicarbonate results. A total of 145 consecutive patients (mean age, 44±13 years; 98 females) were diagnosed with EPI (n = 32; 22%) or normal exocrine pancreatic function (n = 131, 78%). S-MPD/B-MPD ratios in the tail 4 and 8 minutes after secretin were higher in the group with normal exocrine function. Ratios at other times, locations, and duodenal fluid volumes were similar between the 2 groups. A statistically significant change in the median percentage likelihood of chronic pancreatitis was noted after secretin in all groups. The sensitivity and specificity of EPI for the EUS diagnosis of chronic pancreatitis (≥5 criteria) were 23.4% (95% confidence interval, 12.3-38.0) and 78.6% (95% confidence interval, 69.1-86.2), respectively. Real-time EUS findings and ePFTs have a significant impact on the clinical assessment of MCCP. The diagnosis of EPI shows poor correlation with the EUS diagnosis of MCCP. (Clinical trial registration number: NCT01997476.)
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影响因子：
24.5
作者：
SCHMITZMOORMANN, P;HIMMELMANN, GW;WIENBECK, M
通讯作者：
WIENBECK, M
影响因子：
12.6
作者：
Stevens, Tyler;Dumot, John A.;Conwell, Darwin L.
通讯作者：
Conwell, Darwin L.
DOI：
10.1038/ajg.2013.148
发表时间：
2013-08
期刊：
The American journal of gastroenterology
影响因子：
--
作者：
Ketwaroo G;Brown A;Young B;Kheraj R;Sawhney M;Mortele KJ;Najarian R;Tewani S;Dasilva D;Freedman S;Sheth S
通讯作者：
Sheth S
影响因子：
9.8
作者：
Stevens, Tyler;Conwell, Darwin L.;Love, Thomas E.
通讯作者：
Love, Thomas E.
影响因子：
19.7
作者：
Tirkes, Temel;Shah, Zarine K.;Dasyam, Anil K.
通讯作者：
Dasyam, Anil K.