Gregory A Coté, Badih Joseph Elmunzer, Haley Nitchie, Richard S Kwon, Field Willingham, Sachin Wani, Vladimir Kushnir, Amitabh Chak, Vikesh Singh, Georgios I Papachristou, Adam Slivka, Martin Freeman, Srinivas Gaddam, Priya Jamidar, Paul Tarnasky, Shyam Varadarajulu, Lydia D Foster, Peter Cotton
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Patients undergoing first-time endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy for suspected SOD were eligible: pancreatobiliary-type pain with or without iAP. The primary outcome was defined as the composite of improvement by Patient Global Impression of Change (PGIC), no new or increased opioids and no repeat intervention. Missing data were addressed by hierarchal, multiple imputation scheme.</p><p><strong>Results: </strong>Of 316 screened, 213 were enrolled with 190 (89.2%) of these having a dilated bile duct, abnormal labs, iAP or some combination. By imputation, an average of 122/213 (57.4% (95% CI 50.4% to 64.4%)) improved; response rate was similar for those with complete follow-up (99/161, 61.5% (54.0% to 69.0%)); of these, 118 (73.3%) improved by PGIC alone. Duct size, elevated labs and patient characteristics were not associated with response. 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引用次数: 0
摘要
目的:特发性急性胰腺炎(iAP)患者的腹痛可能是由于 Oddi括约肌受压引起的。本研究旨在衡量括约肌切开术对疑似 SOD 患者的益处:设计:在 14 个美国中心进行的前瞻性队列研究,随访 12 个月。因疑似 SOD 而首次接受内镜逆行胰胆管造影术 (ERCP) 并行括约肌切开术的患者均符合以下条件:伴有或不伴有 iAP 的胰胆管型疼痛。主要结果定义为:患者总体变化印象(PGIC)改善、无新的或增加的阿片类药物、无重复干预的综合结果。缺失数据通过分层多重估算方案进行处理:在筛选出的 316 人中,有 213 人被纳入治疗,其中 190 人(89.2%)患有胆管扩张、实验室检查异常、iAP 或某些合并症。通过估算,平均每213人中有122人(57.4% (95% CI 50.4% to 64.4%))的病情有所改善;完全随访者的响应率与此相似(99/161,61.5% (54.0% to 69.0%));其中118人(73.3%)的病情仅通过PGIC有所改善。导管大小、化验指标升高和患者特征与反应无关。在ERCP术后中位6个月,37/213(17.4%)的患者出现了AP,而有AP病史的患者更有可能出现AP(30.9% vs 2.9%,P结论:近 60% 因疑似 SOD 而接受 ERCP 的患者病情有所好转,但安慰剂反应的作用尚不清楚。与普遍看法相反,导管大小和实验室检查是不良反应的预测因素。AP 复发很常见,这与之前非干预队列的观察结果一致,表明括约肌切开术对减轻未来 AP 发作没有益处。
Sphincterotomy for biliary sphincter of Oddi disorder and idiopathic acute recurrent pancreatitis: the RESPOnD longitudinal cohort.
Objective: Sphincter of Oddi disorders (SOD) are contentious conditions in patients whose abdominal pain, idiopathic acute pancreatitis (iAP) might arise from pressurisation at the sphincter of Oddi. The present study aimed to measure the benefit of sphincterotomy for suspected SOD.
Design: Prospective cohort conducted at 14 US centres with 12 months follow-up. Patients undergoing first-time endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy for suspected SOD were eligible: pancreatobiliary-type pain with or without iAP. The primary outcome was defined as the composite of improvement by Patient Global Impression of Change (PGIC), no new or increased opioids and no repeat intervention. Missing data were addressed by hierarchal, multiple imputation scheme.
Results: Of 316 screened, 213 were enrolled with 190 (89.2%) of these having a dilated bile duct, abnormal labs, iAP or some combination. By imputation, an average of 122/213 (57.4% (95% CI 50.4% to 64.4%)) improved; response rate was similar for those with complete follow-up (99/161, 61.5% (54.0% to 69.0%)); of these, 118 (73.3%) improved by PGIC alone. Duct size, elevated labs and patient characteristics were not associated with response. AP occurred in 37/213 (17.4%) at a median of 6 months post ERCP and was more likely in those with a history of AP (30.9% vs 2.9%, p<0.0001).
Conclusion: Nearly 60% of patients undergoing ERCP for suspected SOD improve, although the contribution of a placebo response is unknown. Contrary to prevailing belief, duct size and labs are poor response predictors. AP recurrence was common and like observations from prior non-intervention cohorts, suggesting no benefit of sphincterotomy in mitigating future AP episodes.
期刊介绍:
Gut is a renowned international journal specializing in gastroenterology and hepatology, known for its high-quality clinical research covering the alimentary tract, liver, biliary tree, and pancreas. It offers authoritative and current coverage across all aspects of gastroenterology and hepatology, featuring articles on emerging disease mechanisms and innovative diagnostic and therapeutic approaches authored by leading experts.
As the flagship journal of BMJ's gastroenterology portfolio, Gut is accompanied by two companion journals: Frontline Gastroenterology, focusing on education and practice-oriented papers, and BMJ Open Gastroenterology for open access original research.