慢性胰腺炎的内镜治疗进展

内镜治疗可以缓解慢性胰腺炎症状，扩展了治疗的手段。目前内镜治疗已替代大部分手术治疗，本廉洁慢性胰腺炎和并发症的内镜治疗方法及其疗效与安全性评价作一综述。     

慢性胰腺炎的内镜治疗进展

内镜治疗可以缓解慢性胰腺炎症状,扩展了治疗的手段。目前内镜治疗已替代大部分手术治疗。本文就慢性胰腺炎和并发症的内镜治疗方法及其疗效与安全性评价作一综述。     

青少年慢性胰腺炎的内镜诊断与治疗

目的：研究诊断性和治疗性经内镜逆行胰胆管造影术(ERCP)在青少年慢性胰腺炎(CP)诊断及治疗中的价值。方法：回顾分析1997年2月～2002年2月间确诊为青少年CP并行ERCP的13例临床资料。结果：13例中12例存在腹痛症状，10例有“胰腺炎”病史。ERCP见胰管扩张12例，胰管结石7例，胰腺假性囊肿2例，胰腺分裂症3例，胆囊结石l例。内镜下治疗：乳头括约肌切开术7例，胰管取石6例，支架置入5例，胰管狭窄扩张术4例，副乳头切开2例。ERCP后高淀粉酶血症4例，胰腺炎急性发作3例，均为水肿型胰腺炎。经6—68个月随访，ll例未复发，2例复发者经再次ER-CP治疗后腹痛未再出现。结论：ERCP对青少年CP的诊断及治疗有较高的价值。但青少年CP患者ERCP术后具有较高的并发症发生率，对此内镜医师应高度重视。     

内镜治疗慢性胰腺炎的探讨

目的 探讨内镜治疗慢性阻塞性胰腺炎疗效及并发症。方法 经内镜治疗２９例慢性胰腺炎中胰管括约肌切开术２７例（１９例为７内镜治疗前处置）,副乳头切开８例,乳头括约肌切开术５例,网篮邓胰石９例,胰管内引流７例,鼻胰管引流３例,辅助探条或球囊扩张共１４例。１３例治疗前、后检测胰腺内分泌功能。结果 ２９例中２６例（８９．７％）治疗后腹痛消失或明显减轻,９例胰腺结石患者中６例取出胰石;７例胰管内引流管未阻塞。     

慢性胰腺炎内镜治疗现状

慢性胰腺炎发病率不断攀高,但由于其确切的病因和发病机制尚不清楚,给治疗带来较大困难.近年来,内镜治疗技术的飞速发展,为慢性胰腺炎的治疗提供了新的方向.本文详述慢性胰腺炎内镜治疗的现状和进展,指出存在的问题和困难,对慢性胰腺炎内镜治疗的进一步发展具有指导意义.     

内镜治疗慢性胰腺炎的应用进展

慢性胰腺炎(CP)反复发作,逐渐引起胰腺不可逆的病理变化,出现慢性腹痛及内外分泌功能障碍。目前,CP的治疗仍是一大难题,随着内镜技术的发展,内镜在治疗CP中的作用得到了广泛的关注。内镜治疗主要是针对慢性阻塞性胰腺炎,其目的为解除胰管内压力,缓解疼痛,改善胰腺内外分泌功能。现就此问题作一综述。     

慢性胰腺炎的内镜治疗

慢性胰腺炎治疗目的为解除胰管梗阻、缓解疼痛、防止复发，并争取改善胰腺外分泌功能。过去传统的治疗方法主要有内科长期药物维持治疗及外科减压手术等，但疗效均欠佳。目前内镜治疗在一定程度上可替代手术治疗，成为治疗慢性胰腺炎的首选方案。     

慢性胰腺炎的内镜介入治疗

慢性胰腺炎的最常见原因是慢性酒精中毒和特发性慢性胰腺炎,少见的原因为遗传性胰腺炎、甲状旁腺功能亢进、胰管狭窄、胰管结石或癌肿引起的胰总管阻塞等。慢性胰腺炎影像检查可见胰管狭窄、扩张、假性囊肿形成及胰管结石,继而导致反复发作上腹痛、消瘦、脂肪泻及糖尿病等临床症状。慢性胰腺炎的治疗目的为解除胰管梗阻、缓解疼痛、     

胰腺炎的内镜治疗

消化内镜技术的发展,使不少疾病治疗在内镜下得以完成。急性胰腺炎一度成为内镜诊断和治疗的禁区,而慢性胰腺炎内科治疗往往难以取得理想的效果。近些年来,许多国外学者开展了这方面的工作,国内也见报道,但;临床医师对此仍无足够的认识。本文将介绍内镜下胰腺炎的治疗。急性胰腺炎的内镜治疗急性胰腺炎是临床常见疾病,处理不及时,将会引起局部或全身性并发症,死亡率极高。急性胰腺炎的内镜治疗包括乳头括约肌切开术、腹腔镜下灌洗引流、腹腔镜下药物注射或低温疗法,以前两者应用较多。一、乳头括约肌切开术：胆源性胰腺炎约占胰腺…     

胰腺炎的内镜治疗

本文就急性胆石性胰腺炎、慢性胰腺炎、胰腺分裂所致胰腺炎及胰腺假性囊肿的内镜冶疗做一综述。 1 急性胆石性胰腺炎 急性胆石性胰腺炎的发生与结石嵌顿于瓦特氏壶腹,小的可移动结石反复排出及大结石间歇性梗阻致胰腺引流不畅有关,同样解除梗阻对稳定急性胰腺炎的发展和促进胰腺炎恢复有着同样的作用。急性胆石性胰腺炎的诊断需依靠     

Endoscopic treatment of chronic pancreatitis

Treatment of chronic pancreatitis has been exclusively surgical for a long time. Recently, endoscopic therapy has become widely used as a primary therapeutic option. Initially performed for drainage of pancreatic cysts and pseudocysts, endoscopic treatments were adapted to biliary and pancreatic ducts stenosis. Pancreatic sphincterotomy which allows access to pancreatic ducts was firstly reported. Secondly, endoscopic methods of stenting, dilatation, and stones extraction of the bile ducts were applied to pancreatic ducts. Nevertheless, new improvements were necessary： failures of pancreatic stone extraction justified the development of extra-corporeal shock wave lithotripsy; dilatation of pancreatic stenosis was improved by forage with a new device; moreover endosonography allowed guidance for celiac block, gastro-cystostomy, duodeno-cystostomy and pancreatico-gastrostomy. Although endoscopic treatments are more and more frequently accepted, indications are still debated.     

Endoscopic treatment of chronic pancreatitis

OBJECTIVES: Endoscopy offers an alternative to surgery for the treatment of ductal complications in patients with chronic pancreatitis. The aim of this study was to evaluate the efficacy of endoscopic treatment on pain, cholestasis and pseudocysts in these patients. PATIENTS AND METHODS: Thirty-nine patients (37 M, 2 F, mean age 44), were included in the study. All patients had at least one of the following criteria demonstrated by imaging tests: dilatation of the main pancreatic duct (MPD) with or without stricture (N = 13), bile duct stricture (N = 12), or pancreatic pseudocyst (N = 14) with pancreatic duct stricture (N = 11) or biliary stricture (N = 3). Pancreatic or biliary sphincterotomy, insertion of pancreatic or biliary stent, pseudocyst drainage with stent placement were performed according to ductal abnormalities. Patients were evaluated early and followed up during the stenting period, and after stent removal. RESULTS: Patients underwent a median of 3.5 endoscopic procedures with an interval of 2.2 months between 2 stenting sessions. A pancreatic or biliary stent was inserted in 25 patients with ductal abnormalities and in 11 patients with pseudocysts. Endoscopic pseudocyst drainage was performed in 6 cases. The mean stenting time was 6 months (range: 3-21). Mean follow-up after stent removal was 9.7 (2-48) months. Complications of endoscopic treatment were encountered in 7% of patients with no deaths. Pain relief was achieved after the first endoscopic procedure and during the overall stenting period in all patients. Recurrence of pain was observed after stent removal in 5/11 patients, requiring surgery in 4. Cholestasis decreased and biochemical values normalized within one month after biliary stenting. Recurrence of cholestasis was observed early after stent removal in 4/9 patients who required complementary surgical treatment. No recurrence of pancreatic pseudocyst was observed after endoscopic drainage and stent removal during the follow-up period. CONCLUSIONS: Endoscopic treatment of pain from pancreatic pseudocysts or ductal strictures is effective in the short-term and in the period of ductal stenting. However, the optimal duration of the latter remains to be determined.     

Endoscopic treatment of chronic pancreatitis.

Endoscopic therapies, originally utilized for problems in the biliary tree, have been adapted for use in the pancreas. Despite widespread adoption and implementation of these techniques, there are few controlled studies comparing pancreatic endotherapy with either surgery or traditional medical treatment. This review attempts to summarize current endoscopic practice in treating the ductal obstructions and leaks associated with chronic pancreatitis and place these techniques into perspective with respect to alternative management strategies.     

青少年慢性胰腺炎的内镜介入治疗

目的探讨内镜介入治疗青少年慢性胰腺炎的方法和临床疗效。方法以2002年亚太共识报告中提出的共识意见为慢性胰腺炎诊断标准，回顾分析1997年1月到2006年8月间经内镜介入治疗的青少年慢性胰腺炎患者临床资料，内镜治疗方法等，并随访其疗效。结果36例青少年慢性胰腺炎患者，共行ERCP77次，其中1例2次插管失败，1例胰管置入术未成功，2例失访；成功进行内镜介入治疗和随访的32例患者中，内镜治疗后完全缓解和部分缓解者共26例（81．2％），4例最终行手术治疗；ERCP术后并发症发生率为26．7％（20／75），均经短期药物治疗后好转，无出血、穿孔、死亡病例。结论内镜在治疗青少年慢性胰腺炎方面的初步疗效确切，可作为青少年慢性胰腺炎的一线治疗方法。     

Endoscopic treatment for biliary stricture secondary to chronic pancreatitis

The causes of benign biliary stricture include chronic pancreatitis, primary/immunoglobulin G4-related sclerosing cholangitis and complications of surgical procedures. Biliary stricture due to fibrosis as a result of inflammation is sometimes encountered in patients with chronic pancreatitis. Frey's procedure, which can provide pancreatic duct drainage with decompression of biliary stricture, can be an initial treatment for chronic pancreatitis with pancreatic and bile duct strictures with upstream dilation. When patients are high-risk surgical candidates or hesitate to undergo surgery, endoscopic treatment appears to be a potential second-line therapy. Placement of multiple plastic stents is currently considered to be the best choice as endoscopic treatment for biliary stricture due to chronic pancreatitis. Temporary placement with a fully covered metal stent has become an attractive option due to the lesser number of endoscopic retrograde cholangiopancreatography (ERCP) sessions and its large diameter. Further clinical trials comparing multiple placement of plastic stents with placement of a covered metal stent for biliary stricture secondary to chronic pancreatitis are awaited.     

Endoscopic management of chronic pancreatitis

Chronic pancreatitis (CP) is a common gastrointestinal illness, which affects the quality of life with substantial morbidity and mortality. The management includes medical, endoscopic and surgical approaches with the need for interaction between various specialties, calling for a concerted multidisciplinary approach. However, at the time of this publication, guidelines to establish care of these patients are lacking. This review provides the reader with a comprehensive overview of the studies summarizing the various treatment options available, including medical, surgical and endoscopic options. In addition, technological advances such as endoscopic retrograde cholangiopancreatogrophy, endoscopic shock wave lithotripsy and endoscopic ultrasound can now be offered with reasonable success for pancreatic decompression, stricture dilatation with stent placement, stone fragmentation, pseudocyst drainage, and other endoscopic interventions such as celiac plexus block for pain relief. We emphasize the endoscopic op-tions in this review, and attempt to extract the most up to date information from the current literature. The treatment of CP and its complications are discussed extensively. Complications such as biliary strictures. pancreatic pseudocysts, and chronic pain are common issues that arise as long-term complications of CP. These often require endoscopic or surgical management and possibly a combination of approaches, however choosing amongst the various therapeutic and palliative modalities while weighing the risks and benefits, makes the management of CP challenging. Treatment goals should be not just to control symptoms but also to prevent disease progression. Our aim in this paper is to advocate and emphasize an evidence based approach for the management of CP and associated long term complications.     

Endoscopic diagnosis of chronic pancreatitis

Endoscopy entered the diagnosis of pancreatic diseases in 1972 as the first endoscopic retrograde cholangiopancreaticography and during subsequent decades it markedly extended its field of action to comprise also endoscopic therapy of the pancreas. At present it represents together with abdominal sonography, computed tomography, endosonography, and nuclear magnetic resonance the basic spectrum of morphological examination methods of the pancreas. The disadvantage of endoscopic retrograde cholangiopancreaticography is the invasive character of this method associated with complications. In chronic pancreatitis this method can be used in particular to evaluate the extent of morphological changes--i.e. classification of chronic pancreatitis, whereby the most frequently used one is the Cambridge classification. The method, contrary to other morphological imaging methods can diagnose variants and malformations of the pancreatic efferent system, it cannot however, with the exception of chronic obstructive pancreatitis and chronic pancreatitis in pancreas divisum detect the cause of chronic pancreatitis and is also of very limited informative value in the differential diagnosis of chronic pancreatitis and carcinoma of the pancreas. Endoscopic retrograde pancreaticography cannot be implemented after some surgical operations of the pancreas.     

Endoscopic ultrasound in chronic pancreatitis

Endoscopic ultrasound has continuously gained importance and has proven to be of clinical value in patients with chronic pancreatitis. In addition, the much lower complication rate when compared to ERCP has to be recognised. Some authors have indicated that endoscopic ultrasound in the evaluation of chronic pancreatitis is the imaging method of choice, depending on both ductal and parenchymal criteria, but there are still some limitations. The two major limitations of EUS preventing it being the "gold standard" in patients with chronic pancreatitis are the lack of standard criteria to be used, and adequate education. Endoscopic ultrasound is difficult to learn and therefore teaching has to be standardised. A general acceptance of the staging of chronic pancreatitis using a catalogue based on criteria compatible to the Cambridge classification is required. Difficulties in evaluating parenchymal criteria with the exception of "indicative" calcifications, depend on the differentiation of the normal ageing process from sequelae of acute pancreatic, ethyl-toxic fibrosis and early stages of chronic pancreatitis. In addition, the differentiation of hypoechoic and cystic lesions as inflammatory changes or neoplastic tumours is still difficult; complementary imaging methods also have low sensitivity in this area. In conclusion, there is no doubt that endoscopic ultrasound has proven to be of value using an interdisciplinary approach in the evaluation and therapy of pseudocysts, peripancreatic necrosis, and pancreatic and bile duct obstruction.