Efficacy and prognosis of biliary drainage via endoscopic retrograde cholangiopancreatography in autoimmune pancreatitis with obstructive jaundice
10.3760/cma.j.cn321463-20240604-00186
- VernacularTitle:内镜逆行胰胆管造影术下胆管引流治疗自身免疫性胰腺炎合并梗阻性黄疸的疗效及预后研究
- Author:
Jiaheng XU
1
;
Yatao TU
1
;
Liqi SUN
1
;
Dongling WAN
1
;
Yue LIU
1
;
Chao LIU
1
;
Mengruo JIANG
1
;
Yuyan ZHOU
1
;
Xinyue WANG
1
;
Haojie HUANG
1
Author Information
1. 海军军医大学第一附属医院消化内科，上海 200433
- Publication Type:Journal Article
- Keywords:
Pancreatitis;
Autoimmune pancreatitis;
Cholangiopancreatography, endoscopic retrograde;
Obstructive jaundice;
Prognosis
- From:
Chinese Journal of Digestive Endoscopy
2025;42(7):527-531
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the efficacy and prognosis of biliary drainage via endoscopic retrograde cholangiopancreatography (ERCP) before steroid therapy in treating autoimmune pancreatitis (AIP) complicated with obstructive jaundice.Methods:A retrospective analysis was performed on clinical data of patients with AIP complicated with obstructive jaundice who received steroid therapy at the First Affiliated Hospital of Naval Medical University from 2010 to 2023. Patients were divided into a drainage group (receiving ERCP biliary drainage before steroid therapy) and a steroid group (receiving only steroid therapy). Short-term efficacy, long-term efficacy, hospitalization costs and postoperative complications of ERCP biliary drainage were compared between the two groups.Results:A total of 69 patients were included, with 32 in the drainage group, aged 62.78±11.21 years, which demonstrated significantly higher costs (34 816.57±11 688.85 yuan VS 16 518.50±6 544.37 yuan, t=7.0, P<0.001), with 25.00% (8/32) experiencing ERCP-related complications, compared with 37 patients in the steroid group, aged 55.41±2.15 years. There was no significant difference in hospitalization duration between the drainage group (10.38±4.56 days) and the steroid group (8.95±4.99 days, t=1.2, P=0.219). After 1 month of treatment, total bilirubin [118.5 (76.2, 309.3) μmol/L VS 48.7 (30.5, 148.4) μmol/L, U=1 728.5, P<0.001] and direct bilirubin [84.5 (47.7, 236.3) μmol/L VS 37.7 (18.3, 105.7) μmol/L, U=1 588.5, P=0.001] levels in the drainage group remained higher than those in the steroid group, while alanine aminotransferase levels were lower [74.0 (46.5,110.5) U/L VS 143.0 (51.0,253.5) U/L, U=769.0, P=0.006]. No significant differences were observed in these biochemical indices between the two groups at 4-month and 12-month follow-ups ( P>0.05). The recurrence rates were 28.1% (9/32) in the drainage group and 21.6% (8/37) in the steroid group, with no significant difference in recurrence rate between groups ( χ2=0.4, P=0.266). Conclusion:ERCP biliary drainage does not significantly improve long-term efficacy or reduce recurrence rates in AIP patients with obstructive jaundice. Instead, it increases the risk of postoperative complications and medical costs. Direct steroid therapy is safe and feasible for confirmed AIP with obstructive jaundice.
