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对于急性胆源性胰腺炎,内镜治疗具有重要的地位。行内镜逆行胰胆管造影术(ERCP)及内镜超声检查可明确诊断,指导进一步治疗。早期行经内镜鼻胆管引流(ENBD)、经内镜乳头括约肌切开术(EST)、胰管支架置入可及时解除梗阻,降低胆管、胰管压力,引流胆汁及胰液,缓解胰腺炎,降低并发症的发生率。内镜治疗可能导致出血、穿孔、胰腺炎加重、腹膜后感染等严重并发症,因此应严格掌握适应证,对于伴有急性胆管炎的急性胆源性胰腺炎,早期内镜治疗是绝对适应证;对于不伴有急性胆管炎的重症急性胰腺炎,应严密观察,除留置空肠营养管之外的早期内镜治疗并没有明显益处。

Role of endoscopic therapy in acute biliary pancreatitis

Endoscopic therapy plays an important role in acute biliary pancreatitis(ABP).Endoscopic retrograde cholangiopancreatography(ERCP) and endoscopic ultrasound(EUS) are helpful in diagnosis and further therapy of ABP.Early endoscopic nasobiliary drainage(ENBD),endoscopic sphincteropapillotomy(EST) and pancreatic duct stent placement can remove biliopancreatic obstruction,reduce pressure of bile duct and pancreatic duct,drain bile and pancreatic juice,release pancreatitis and reduce incidence of complications.However,severe complications such as hemorrhage,perforation,pancreatitis exacerbation and retroperitoneal infection can be caused by endoscopic therapy.Therefore,indications should be strictly controlled.Early ERCP should be performed only in patients with ABP complicated with acute cholangiolitis.Patients with SAP without acute cholangiolitis do not benefit from early ERCP except jejunum nutrition tube,and they should be observed closely.