Background: Pancreatitis is the most common major complication of ERCP. Efforts have been made to identify pharmacologic agents capable of reducing its incidence and severity. The aim of this trial was to determine wh...Background: Pancreatitis is the most common major complication of ERCP. Efforts have been made to identify pharmacologic agents capable of reducing its incidence and severity. The aim of this trial was to determine whether prophylactic allopurinol, an inhibitor of oxygen-derived free radical production, would reduce the frequency and severity of post-ERCP pancreatitis. Methods: A total of 701 patients were randomized to receive either allopurinol or placebo 4 hours and 1 hour before ERCP. A database was prospectively collected by a defined protocol on patients who underwent ERCP. Standardized criteria were used to diagnose and grade the severity of postprocedure pancreatitis. Results: The groups were similar with regard to patient demographics and to patient and procedure risk factors for pancreatitis. The overall incidence of pancreatitis was 12.55% . It occurred in 46 of 355 patients in the allopurinol group (12.96% )- and in 42 of 346 patients in the control group (12.14% ; p = 0.52). The pancreatitis was graded mild in 7.89% , moderate in 4.51% , and severe in 0.56% of the allopurinol group, and mild in 6.94% ,moderate in 4.62% , and severe in 0.58% of the control group. There was no significant difference between the groups in the frequency or the severity of pancreatitis. Conclusions: Prophylactic oral allopurinol did not reduce the frequency or the severity of post-ERCP pancreatitis.展开更多
Background: Self- expandable metal stents (SEMS) are being increasingly used to palliate malignant stenoses of the gastric outlet and proximal small bowel. Accordingly, we reviewed our experience in this setting. Meth...Background: Self- expandable metal stents (SEMS) are being increasingly used to palliate malignant stenoses of the gastric outlet and proximal small bowel. Accordingly, we reviewed our experience in this setting. Methods: Patients with gastric outlet or proximal small bowel stents were identified by reviewing hospi tal charts. Outcome criteria included survival data, need for reintervention, an d clinical improvement. Results: A total of 52 SEMS were placed in 36 patients w ith nonesophageal upper GI stenosis. Initial stent placement was successful in 9 2% and clinical improvement documented in 75% . Mean survival of patients who eventually died was 3.5 months. Seven patients are alive (mean follow- up, 5.0 months). Stent dysfunction occurred in 36% and required subsequent interventi ons. Biliary obstruction was documented in 50% of patients, 12 of whom had pre viously undergone biliary stenting and 5 who needed subsequent biliary decompres sion. Conclusions: Enteral stent placement has been reported to be an effective alternative for palliation of high- risk surgical patients with malignant gastr ic outlet and small bowel obstruction. Considering the short life expectancy of these patients and significant complications including stent mi gration, perforation, biliary obstruction, and need for subsequent endoscopic , radiologic and surgical interventions, the authors suggest that this procedure be performed in experienced centers on selected patients only and that biliary decompression be ensured early.展开更多
文摘Background: Pancreatitis is the most common major complication of ERCP. Efforts have been made to identify pharmacologic agents capable of reducing its incidence and severity. The aim of this trial was to determine whether prophylactic allopurinol, an inhibitor of oxygen-derived free radical production, would reduce the frequency and severity of post-ERCP pancreatitis. Methods: A total of 701 patients were randomized to receive either allopurinol or placebo 4 hours and 1 hour before ERCP. A database was prospectively collected by a defined protocol on patients who underwent ERCP. Standardized criteria were used to diagnose and grade the severity of postprocedure pancreatitis. Results: The groups were similar with regard to patient demographics and to patient and procedure risk factors for pancreatitis. The overall incidence of pancreatitis was 12.55% . It occurred in 46 of 355 patients in the allopurinol group (12.96% )- and in 42 of 346 patients in the control group (12.14% ; p = 0.52). The pancreatitis was graded mild in 7.89% , moderate in 4.51% , and severe in 0.56% of the allopurinol group, and mild in 6.94% ,moderate in 4.62% , and severe in 0.58% of the control group. There was no significant difference between the groups in the frequency or the severity of pancreatitis. Conclusions: Prophylactic oral allopurinol did not reduce the frequency or the severity of post-ERCP pancreatitis.
文摘Background: Self- expandable metal stents (SEMS) are being increasingly used to palliate malignant stenoses of the gastric outlet and proximal small bowel. Accordingly, we reviewed our experience in this setting. Methods: Patients with gastric outlet or proximal small bowel stents were identified by reviewing hospi tal charts. Outcome criteria included survival data, need for reintervention, an d clinical improvement. Results: A total of 52 SEMS were placed in 36 patients w ith nonesophageal upper GI stenosis. Initial stent placement was successful in 9 2% and clinical improvement documented in 75% . Mean survival of patients who eventually died was 3.5 months. Seven patients are alive (mean follow- up, 5.0 months). Stent dysfunction occurred in 36% and required subsequent interventi ons. Biliary obstruction was documented in 50% of patients, 12 of whom had pre viously undergone biliary stenting and 5 who needed subsequent biliary decompres sion. Conclusions: Enteral stent placement has been reported to be an effective alternative for palliation of high- risk surgical patients with malignant gastr ic outlet and small bowel obstruction. Considering the short life expectancy of these patients and significant complications including stent mi gration, perforation, biliary obstruction, and need for subsequent endoscopic , radiologic and surgical interventions, the authors suggest that this procedure be performed in experienced centers on selected patients only and that biliary decompression be ensured early.
