The Clinical Study Of Endoscopic Diagnosis And Treatment In Patients With Chronic Pancreatitis

Backgroud:Chronic pancreatitis(CP)is a chronic,progressive and inflammatory disease.It is quite difficult for both medicine and surgery to treat it. But with the development of endoscopy technique,most of patients with CP accept endoscopic treatment as their first choice for its convenient operation,lower complications and satisfied outcome.Objective:To investigate the clinical value of endoscopic diagnosis for CP,to evaluate the clinical effect and security of endoscopic treatment for CP.Method:Select 32 hospitalized patients of TianJin Nankai hospital between 2004.1 and 2008.5,all of whom received endoscopic treatment.Analyze the results of Ultrasound,Computed Tomography(CT),Magnetic Resonance Cholangiopancreatography(MRCP)and endoscopic retrograde cholangiopancreatography(ERCP)diagnose CP,to establish the best method for diagnosing CP;follow up their clinical therapeutic effect after endoscopic treatment using telephone or clinic service by observe the BMI and abdominal pain changes after endoscopic treatment.Result:32 patients who consistented with CP diagnostic criteria were selected.All of them received endoscopic treatment,performance achievement ratio 90.3%(29/32).8 patients received endoscopic pancreatic sphincterotomy(EPS), 3(9.4%)dilated pancreatic duct by the balloon;7(24.1%)had the pancreatic stone extracted with endoscopy,13(44.8%)l treated with main pancreatic duct stent,and 1 (3.4%)treated with accessory pancreatic duct stent,5(17.2%)received pseudocyst draining through gastric wall,3(10.3%)endoscopic treatment unsuccessed.The diagnosis accuracy rate of ultrasound,CT,MRCP and ERCP were 65.6%(21/32), 73.1%(19/26),81.8%(18/22)和93.1%(27/29)respectively.29 patients were followed up for 1-45 months,their abdominal pain significantly relieved(P＜0.05).The abdominal pain of 24(82.8%)patients relieved when they were followed up 2 weeks later,while there were 11 patients whose abdominal pain relieved up to 2 years.The body weight of the patients after treatment was significantly increased(P＜0.05),and their body weight averagely increased 2-10 Kg after treatment.The patients'BMI before treatment was22.09±3.78,and 25.03±3.42 after treatment.3 of 14 patients who received pancreatic duct stand took out of the stents18-34 days after the operation,because there was no obviously improvement of abdominal pain,and then received the surgical intervention.For another 11patients,6 took out of their stents in 9 months later(exchanged the stents 1-2 times),3 took the stents for more than 12 months without exchanging while there was no abdominal pain recurred,2 took the stems less than 3 months.1 patient's stent amotioed and 1 migrated within 6 months after operation.32 patients received therapeutic endoscopy 43 times,the post-operation complications are 2 patients had acute pancreatitis,7 had hyperamylasemia and 5 patients suffered nausea and vomiting.There were no haemorrhage,infection, perforation and acute cholangitis.Conclusion:1 Endoscopic diagnosis of CP has higher accuracy and sensitivity.It is the golden standard among the examinations.ERCP combined ultrasound and CT can improve the diagnosis accuracy,which is the best approach we suggest.2 Endoscopic treatment of CP can effectively relieve the abdominal pain and the patients'BMI would increase.The advantage of Endoscoy is minimally invasive, lower complications and satisfied outcome.It indicates that endoscopy is an effective therapeutic method for CP.