基于超声波的新型胰腺支架检测算法:一项前瞻性试验。

IF 3.1 3区 医学 Q1 ACOUSTICS
Florian Alexander Michael, Clara Feldmann, Hans-Peter Erasmus, Alica Kubesch, Esra Goerguelue, Mate Knabe, Nada Abedin, Myriam Heilani, Daniel Hessz, Christiana Graf, Dirk Walter, Fabian Finkelmeier, Ulrike Mihm, Neelam Lingwal, Stefan Zeuzem, Joerg Bojunga, Mireen Friedrich-Rust, Georg Dultz
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引用次数: 0

摘要

目的:在内镜逆行胰胆管造影术中放置了胰腺支架,为避免ERCP术后胰腺炎,建议在取出残留的胰腺支架前进行造影。本研究旨在评估一种基于超声波的新算法。材料和方法:纳入接受胰腺支架以预防 PEP 的患者。在内镜下取出经超声检查可见的带有外瓣的 5Fr(0.035 英寸)6 厘米直支架,不再进行进一步的造影检查。如果超声结果显示支架移位或无法确定,则进行 X 光成像。研究终点为阳性和阴性预测值、特异性、敏感性以及超声与 X 光和/或内窥镜之间的或然系数。有 23 名患者(26%)接受了 X 光检查。因此,超声算法节省了 65 例 X 光检查,减少了 74%。67名患者(76%)保留了支架,54名患者的超声检查结果正确,灵敏度为81%。阳性预测值为 83%。特异性为 48%,因为超声正确描述了 10/21 个移位的支架。阴性预测值为 43%,因为有 10/23 个支架被超声正确归类为移位。有 11 名患者(13%)即使胰腺支架已经移位,仍需进行食管胃十二指肠镜检查。为避免不必要的内镜检查,该算法在实施过程中应有一个学习阶段,且手术应由经验丰富的检查人员进行。一个重要的限制因素可能是支架的长度,因为较短的支架可能更难通过超声显像。__________________ 背景:目前建议在内镜逆行胰胆管造影术后取出预防性放置的胰腺支架前进行成像。本研究旨在评估一种基于超声波的新算法。材料和方法:纳入接受预防性胰腺支架植入术的患者。只需在内镜下取出距外法兰 6 厘米长的 5 Fr 支架(0.035 英寸),超声检查可见,无需进一步成像。如果超声结果显示支架移位,则进行 X 光检查。研究终点为阳性和阴性预测值、特异性、敏感性以及超声与 X 光和/或内窥镜检查之间的或然系数。结果:88 名患者被纳入研究。23名患者(26%)必须进行X光检查。因此,在 65 例患者(74%)中,超声波算法节省了 X 光检查。67名患者(76%)保留了支架,54名患者的超声检查结果正确,灵敏度为81%。阳性预测值为 83%。特异性为 48%,因为超声正确显示了 10/21 个脱位的支架。阴性预测值为 43%,因为有 10/23 个支架被正确归类为脱位。虽然胰腺支架已经脱位,但仍有 11 名患者(13%)进行了食管胃十二指肠镜检查。结论:基于超声波的算法将 X 光成像的需求减少了四分之三。为避免不必要的内镜检查,该算法在实施过程中应有一个学习阶段,且手术应由经验丰富的检查人员进行。一个重要的限制因素可能是支架的长度,因为较短的支架可能更难以用超声波观察到。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A novel ultrasound-based algorithm for the detection of pancreatic stents placed for prophylaxis of post-ERCP pancreatitis: a prospective trial.

Before removal of retained pancreatic stents placed during endoscopic retrograde cholangiopancreatography to avoid post-ERCP pancreatitis, imaging is recommended. The aim of the present study was to evaluate a new ultrasound-based algorithm.Patients who received a pancreatic stent for PEP prophylaxis were included. Straight 5Fr (0.035inch) 6cm stents with an external flap that were visualized by ultrasound were removed endoscopically with no further imaging. If the ultrasound result reported the stent to be dislodged or was inconclusive, X-ray imaging was performed. The endpoints were positive and negative predictive value, specificity, sensitivity, and contingency coefficient between ultrasound and X-ray and/or endoscopy.88 patients were enrolled in the present study. X-ray was performed in 23 (26%) patients. Accordingly, the ultrasound algorithm saved an X-ray examination in 65 cases, leading to a reduction of 74%. Stents were retained in 67 patients (76%) and visualized correctly by ultrasound in 54 patients with a sensitivity of 81%. The positive predictive value was 83%. The specificity was 48%, because ultrasound described 10/21 dislodged stents correctly. The negative predictive value was 43%, since 10/23 stents were correctly classified by ultrasound as dislodged. In 11 patients (13%), esophagogastroduodenoscopy was performed even though the pancreatic stent was already dislodged.A novel ultrasound-based algorithm reduced the need for X-ray imaging by three quarters. To avoid unnecessary endoscopic examinations, the algorithm should be implemented with a learning phase and procedures should be performed by experienced examiners. An important limitation might be stent length since shorter stents might be more difficult to visualize by ultrasound.

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来源期刊
Ultraschall in Der Medizin
Ultraschall in Der Medizin 医学-核医学
CiteScore
5.30
自引率
8.80%
发文量
228
审稿时长
6-12 weeks
期刊介绍: Ultraschall in der Medizin / European Journal of Ultrasound publishes scientific papers and contributions from a variety of disciplines on the diagnostic and therapeutic applications of ultrasound with an emphasis on clinical application. Technical papers with a physiological theme as well as the interaction between ultrasound and biological systems might also occasionally be considered for peer review and publication, provided that the translational relevance is high and the link with clinical applications is tight. The editors and the publishers reserve the right to publish selected articles online only. Authors are welcome to submit supplementary video material. Letters and comments are also accepted, promoting a vivid exchange of opinions and scientific discussions.
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