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首页> 外文期刊>Revista da Associao Médica Brasileira >Microlithiasis of the gallbladder: role of endoscopic ultrasonography in patients with idiopathic acute pancreatitis
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Microlithiasis of the gallbladder: role of endoscopic ultrasonography in patients with idiopathic acute pancreatitis

机译：胆囊微石症：内镜超声检查在特发性急性胰腺炎患者中的作用

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OBJECTIVES: Causes may be found in most cases of acute pancreatitis, however no etiology is found by clinical, biological and imaging investigations in 30% of these cases. Our objective was to evaluate results from endoscopic ultrasonography (EUS) for diagnosis of gallbladder microlithiasis in patients with unexplained (idiopathic) acute pancreatitis. METHODS: Thirty-six consecutive non-alcoholic patients with diagnoses of acute pancreatitis were studied over a five-year period. None of them showed signs of gallstones on transabdominal ultrasound or tomography. We performed EUS within one week of diagnosing acute pancreatitis. Diagnosis of gallbladder microlithiasis on EUS was based upon findings of hyperechoic signals of 0.5-3.0 mm, with or without acoustic shadowing. All patients (36 cases) underwent cholecystectomy, in accordance with indication from the attending physician or based upon EUS diagnosis. RESULTS: Twenty-seven patients (75%) had microlithiasis confirmed by histology and nine did not (25%). EUS findings were positive in twenty-five. Two patients had acute cholecystitis diagnosed at EUS that was confirmed by surgical and histological findings. In two patients, EUS showed cholesterolosis and pathological analysis disclosed stones not detected by EUS. EUS diagnosed microlithiasis in four cases not confirmed by surgical treatment. In our study, sensitivity, specificity and positive and negative predictive values to identify gallbladder microlithiasis (with 95% confidence interval) were 92.6% (74.2-98.7%), 55.6% (22.7-84.7%), 86.2% (67.4-95.5%) and 71.4% (30.3-94.9%), respectively. Overall EUS accuracy was 83.2%. CONCLUSIONS: EUS is a very reliable procedure to diagnose gallbladder microlithiasis and should be used for the management of patients with unexplained acute pancreatitis. This procedure should be part of advanced endoscopic evaluation.
机译：目的：在大多数急性胰腺炎病例中都可能找到病因，但是在其中30％的病例中，通过临床，生物学和影像学检查未发现病因。我们的目的是评估内镜超声检查（EUS）对无法解释的（特发性）急性胰腺炎患者胆囊微石症的诊断结果。方法：连续五年对诊断为急性胰腺炎的36例非酒精性患者进行了研究。经腹部超声或断层扫描均未显示胆结石迹象。我们在诊断急性胰腺炎的一周内进行了EUS。 EUS胆囊微石症的诊断是基于0.5-3.0 mm高回声信号的发现，伴有或不伴有声影。根据主治医师的指示或根据EUS诊断，所有患者（36例）均进行了胆囊切除术。结果：27例（75％）经组织学证实为微石症，9例（25％）没有。 EUS结果在25中呈阳性。两名患者在EUS确诊为急性胆囊炎，并通过手术和组织学检查证实。在两名患者中，EUS显示出胆固醇沉着，病理分析显示未通过EUS检测到结石。 EUS诊断为四例未通过手术治疗证实的微石症。在我们的研究中，鉴定胆囊微结石症（置信区间为95％）的敏感性，特异性以及阳性和阴性预测值分别为92.6％（74.2-98.7％），55.6％（22.7-84.7％），86.2％（67.4-95.5％） ）和71.4％（30.3-94.9％）。 EUS总体准确性为83.2％。结论：超声内镜是诊断胆囊微石症的一种非常可靠的方法，应用于治疗原因不明的急性胰腺炎。该程序应作为高级内镜评估的一部分。

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