关键词: 重症急性胰腺炎, 胆道狭窄, 内镜

Abstract: Diagnosis and treatment of biliary stricture following severe acute pancreatitis        NING Cai-hong, HUANG Geng-wen. Division of Pancreatic Surgery, Department of General Surgery, Xiangya Hospital, Central South University, Changsha 410008, China 
Corresponding author: HUANG Geng-wen，E-mail: huanggengwen@csu.edu.cn
Abstract    The advancements in intensive care medicine, along with the introduction of minimally invasive step-up and endoscopic step-up approaches, have significantly improved the prognosis of patients with severe acute pancreatitis (SAP). However, with improvement in short-term efficacy, the long-term complications of SAP have gradually become a focus of clinical concern. Biliary stricture (BS) is a rare but severe late-stage complication of SAP, which can result in life-threatening cholangitis, progressive liver impairment, and secondary biliary cirrhosis. Severe local and systemic inflammatory response, as well as compression from necrotic fluids in the pancreatic head/neck region, are considered two main causes of the development of BS. Additionally, atrial fibrillation, splanchnic vein thrombosis, and pancreatic head necrosis are regarded as independent risk factors for BS. The optimal treatment strategy for SAP-associated BS remains unclear due to the absence of instructive guidelines or consensus. Nevertheless, clinical guidelines for the management of benign BS can be referenced for application in this clinical setting. Endoscopic placement of biliary stents is currently the preferred method for treating BS, with percutaneous intervention and surgical procedures serving as important supplements in cases where endoscopic treatment fails. Prompt removal of necrotic tissues and effective control of inflammation can ameliorate the progression of BS.

Key words: severe acute pancreatitis, biliary stricture, endoscopy