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Indications actuelles de la pancréatographie et de la pancréatoscopie

Current indications for pancreatography and pancreatoscopy

  • Published:
Acta Endoscopica

Résumé

L'importance de la pancréatographie endoscopique rétrograde (PCER) diminue actuellement en raison de la disponibilité de techniques d'efficacité équivalente et dépourvues de complications. L'angiopancréatographie (PCRM) et l'échoendoscopie sont au moins équivalentes dans le diagnostic des maladies pancréatiques et mettent en évidence les altérations canalaires avec une précision comparable. De plus, ces techniques renseignent au sujet des altérations parenchymateuses. Dans la mesure où l'intervention endoscopique n'est pas nécessaire, la PCRM et l'utrasonographie peuvent remplacer les techniques classiques de diagnostic par PCER. La PCER a sa place comme exploration préalable à une intervention endoscopique lorsque la PCRM ne définit pas avec des détails suffisants l'anatomie canalaire ou lorsque l'échoendoscopie n'explique pas les anomalies canalaires observées. La pancréatoscopie est réalisée chez des patients sélectionnés porteurs d'anomalies canalaires mal définies associées à une dilatation des canaux. La principale indication est le diagnostic des néoplasmes pancréatiques mucino-papillaires intra canalaires et leur distinction avec la pancréatite chronique. A l'avenir des instruments de plus fin calibre pourvus d'un meilleur béquillage devraient permettre d'élargir le spectre diagnostique de la mini-endoscopie.

Summary

The importance of endoscopic retrograde pancreatography (ERP) is currently decreasing since equally effective but less complicated tests are available. MR-Cholangiopancreatography and endoscopic ultrasound are at least equivalent for the diagnosis of pancreatic diseases and show ductal changes with similar accuracy. In addition, parenchymal changes can be seen. As long as there is no need for endoscopic intervention, MRCP and EUS can replace or precede a diagnostic ERCP. The ERCP has its place as a test before endoscopic intervention, when MRCP does not define ductal anatomy in sufficient detail, or when EUS does not explain the ductal changes seen. Pancreatoscopy is used in selected patients with unclear intraductal pathology and concurrent ductal dilation. Its main indication is the diagnosis of intraductal papillary-mucinous neoplasias of the pancreas and differentiating these from chronic pancreatitis. Smaller instrument diameter and better tip deflection may be able to increase the diagnostic spectrum of miniature endoscopy in the future.

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  1. St Hildegardis Krankenhaus, Johannes Gutenberg-Universität, Hildegardestrasse, 2, 55131, Mainz, (Allemagne)

    M. Jung & M. Hahn

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  1. M. Jung
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  2. M. Hahn
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Jung, M., Hahn, M. Indications actuelles de la pancréatographie et de la pancréatoscopie. Acta Endosc 30, 477–484 (2000). https://doi.org/10.1007/BF03015798

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  • DOI: https://doi.org/10.1007/BF03015798

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