Nursing Risk Management in the Prevention of Post-ERCP Pancreatitis

Objective:To study the role of nursing risk management in the prevention of post-ERCP pancreatitis.Methods:80 patients who underwent ERCP in our hospital from December 2023 to April 2024 were selected and randomly divided into an observation group and a control group using the random number table method,with 40 cases in each group.The observation group was given nursing risk management interventions and patients in the control group were given routine nursing interventions,and the patients in the two groups were compared in the incidence rate of pancreatitis and the satisfaction of nursing care.Results:The incidence of postoperative pancreatitis in the observation group was significantly lower than in the control group(P<0.05).The patient satisfaction of the observation group was significantly higher than that of the control group(P<0.05).Conclusion:Nursing risk management after ERCP can reduce the incidence of postoperative pancreatitis and improve patient satisfaction.

Risk factors for post-endoscopic retrograde cholangiopancreatography(ERCP) abdominal pain in patients without post-ERCP pancreatitis

Background:Abdominal pain is often observed after endoscopic retrograde cholangiopancreatography(ERCP).Few studies have focused on the risk factors of post-ERCP abdominal pain without post-ERCP pancreatitis(PEP).This study aimed to identify risk factors of post-ERCP abdominal pain without PEP and investigate characteristics of the abdominal pain in non-PEP patients.Methods:Data from patients who underwent ERCP from August 2019 to January 2020 were retrospectively collected.Characteristics of the abdominal pain after ERCP were recorded and compared between PEP and non-PEP patients.Multivariate analysis was conducted to identify risk factors of non-PEP abdominal pain.Results:A total of 1295 ERCP procedures were investigated in this study,among which 100(7.72%)patients presented post-ERCP abdominal pain without PEP and 63(4.86%)patients with PEP.Multivariate analysis found 9 risk factors of non-PEP abdominal pain:age≤65 years[odds ratio(OR):1.971],primary ERCP(OR:2.442),dilated extrahepatic bile duct(OR:1.803),no papilla opening(OR:2.095),pancreatic guidewire passages(OR:2.258),white blood cells(WBC)≤6.0×10^(9)/L(OR:1.689),platelet(PLT)≤250×10^(9)/L(OR:2.505),serumγ-glutamyl transferase(γ-GT)≤35 U/L(OR:2.190),and albumin≥40 g/L(OR:1.762).The PEP group had later pain onset,higher pain frequency and longer hospital stay than those of the non-PEP pain group(P<0.05).There were no significant differences in the pain duration,visual analogue scale score and mortality between the PEP group and non-PEP pain group(P>0.05).Conclusions:This study indicated that age≤65 years,primary ERCP,dilated extrahepatic bile duct,no papilla opening,pancreatic guidewire passages,lower WBC,lower PLT,normalγ-GT and elevated albumin were independent risk factors for post-ERCP abdominal pain without PEP.The pain occurred earlier in non-PEP patients than in PEP patients.

Effect of Post-ERCP Pancreatitis on Perioperative Factors of Pancreaticoduodenectomy

Background:?Endoscopic retrograde cholangiopancreatography (ERCP) is commonly performed for biliary drainage and examination of the biliary and pancreatic duct before pancreaticoduodenectomy (PD). The influence of preoperative post-ERCP pancreatitis on PD is unknown. The aim of this study was to evaluate the relation between post-ERCP pancreatitis before PD and surgical outcomes of PD. Methods: We examined 38 patients who underwent PD. The relations between post-ERCP pancreatitis before PD and perioperative factors of PD such as patient characteristics, operative findings, and postoperative course were evaluated with univariate and multivariate analyses. Results: Post-ERCP pancreatitis was observed in 12 (37.5%) of the 38 patients. Univariate analyses showed operative procedure (P?= 0.034), operation time (P?= 0.004), blood loss (P?= 0.031), C-reactive protein (P?= 0.043), and delayed gastric emptying (P?= 0.035) to be significantly associated with post-ERCP pancreatitis. Multivariate analyses showed operation time (OR, 1.017;?95%CI, 1.000 - 1.034;?P?= 0.049) and delayed gastric emptying (OR, 18.72;95%CI, 1.139 - 307.6;?P?= 0.040) to be significantly associated with post-ERCP pancreatitis. Conclusions: Post-ERCP pancreatitis was associated with prolonged operation time and delayed gastric emptying in patients undergoing PD.

Pancreatits after endoscopic retrograde cholangio-pancreatography

Pancreatitis is the most common complication after endoscopic retrograde cholangio-pancreatography (ERCP); the reported incidence of this complication varies from less than 1% to 40%, but a rate of 4%-8% is reported in most prospective studies involving non-selected patients. Differences in criteria for defining pancreatitis, methods of data collection, and patient populations (i.e. number of high-risk patients included in the published series) are factors that are likely to affect the varying rates of post-ERCP pancreatitis. The severity of post-ERCP pancreatitis (PEP) can range from a minor inconvenience with one or two days of added hospitalization with full recovery to a devastating illness with pancreatic necrosis, multiorgan failure, permanent disability, and even death. Although, most episodes of PEP are mild (about 90%), a small percentage of patients (about 10%) develop moderate or severe pancreatitis. In the past, PEP was often viewed as an unpredictable and unavoidable complication, with no realistic strategy for its avoidance. New data have aided in stratifi cation of patients into PEP risk categories and new measures have been introduced to decrease the risk of PEP. As most ERCPs are performed on an outpatient basis, the majority of patients will not develop PEP and can be discharged. Alternatively, early detection of those patients who will go on to develop PEP can guide decisions regarding hospital admission and aggressive management. In the last decade, great efforts have been addressed toward prevention of this complication. Points of emphasis have included technical measures, pharmacological prophylaxis, and patient selection. This review provides a comprehensive, evidence-based assessment of published data on PEP and current suggestions for its avoidance.

Sphincter of Oddi dysfunction and pancreatitis

Sphincter of Oddi dysfunction (SOD) is a term used to describe a group of heterogenous pain syndromes caused by abnormalities in sphincter contractility. Biliary and pancreatic SOD are each sub-classified as typeⅠ,Ⅱ or Ⅲ,according to the Milwaukee classification. SOD appears to carry an increased risk of acute pancreatitis as well as rates of post ERCP pancreatitis of over 30%. Various mechanisms have been postulated but the exact role of SOD in the pathophysiology of acute pancreatitis is unknown. There is also an association between SOD and chronic pancreatitis but it is still unclear if this is a cause or effect relationship. Management of SOD is aimed at sphincter ablation,usually by endoscopic sphincterotomy (ES). Patients with typeⅠSOD will benefit from ES in 55%-95% of cases. Sphincter of Oddi manometry is not necessary before ES in typeⅠ SOD. For patients with types Ⅱ and Ⅲ the benefit of ES is lower. These patients should be more thoroughly evaluated before performing ES. Some researchers have found that manometry and ablation of both the biliary and pancreatic sphincters is required to adequately assess and treat SOD. In pancreatic SOD up to 88% of patients will benefit from sphincterotomy. Therefore,there have been calls from some quarters for the current classification system to be scrapped in favour of an overall system encompassing both biliary and pancreatic types. Future work should be aimed at understanding the mechanisms underlying the relationship between SOD and pancreatitis and identifying patient factors that will help predict benefit from endoscopic therapy.

Impact of changing our cannulation method on the incidenceof post-endoscopic retrograde cholangiopancreatography pancreatitis after pancreatic guidewire placement

AIM： To clarify whether the incidence of post-endoscopic retrograde cholangiopancreatography （ERCP） pancreatitis （PEP） after pancreatic guidewire placement （PGW） can be reduced by using a different cannulation method. METHODS： BebNeen April 2001 and October 2009, PGW was performed in 142 patients with native papilla to overcome difficult biliary cannulation. Our cannulation method for ERCP was changed from contrast injection （CI） using a single-lumen catheter （April 2001-May 2008） to wire-guided cannulation （WGC） using a double-lumen catheter （June 2008-October 2009）. The CI protocol was also changed during the study period： in the first period it was used for routine pancreatography for detecting small pancreatic cancer （April 2001-November 2002）, whereas in the second period it was not （December 2002-May 2008）. In PGW with CI using a single- lumen catheter, the contrast medium in the catheter lumen was injected into the pancreatic duct. The success rate of biliary cannulation, the incidence of PEP according to the cannulation method, and the impact of CI using a single-lumen catheter on PEP in comparison with WGC using a double-lumen catheter were investigated.RESULTS： CI with routine pancreatography, CI without routine pancreatography, and WGC were performed in 27 patients, 77 patients and 38 patients, respectively. Routine pancreatography did not contribute to the early diagnosis of pancreatic cancer in our study period. In CI without routine pancreatography and WGC, diagnostic pancreatography was performed in 17 patients and no patients, respectively. The success rate of biliary cannulation by PGW alone was 69%, and the final success rate was increased to 80.3% by the addition of consecutive maneuvers or a second ERCP. PEP occurred in 22 patients （15.5%）, and the severity was mild in all cases. When analyzed according to cannulation method, the incidence of PEP was 37.0% （10/27） in the patients who underwent CI with routine pancreatography, 14.3% （11/77） in those who underwent CI without routine pancreatography, and 2.6% （1/38） in those who underwent WGC. In all patients who underwent CI using a singlelumen catheter, the incidence of PEP was 20% （21/104）, which was significantly higher than that in WGC using a double-lumen catheter. In univariate and multivariate analysis, CI using a single-lumen catheter showed a high, statistically significant, odds ratio for PEP after PGW. CONCLUSION： The practice of a cannulation method involving the use of a double-lumen catheter minimizes the CI dose administered to the pancreatic duct and reduces the incidence of PEP after PGW.

Pancreatitis after endoscopic retrograde cholangiopancreatography:A narrative review

Acute post-endoscopic retrograde cholangiopancreatography pancreatitis(PEP)is a feared and potentially fatal complication that can be as high as up to 30%in high-risk patients.Pre-examination measures,during the examination and after the examination are the key to technical and clinical success with a decrease in adverse events.Several studies have debated on the subject,however,numerous topics remain controversial,such as the effectiveness of prophylactic medications and the amylase dosage time.This review was designed to provide an update on the current scientific evidence regarding PEP available in the literature.

Helicobacter pylori and pancreatic diseases

A possible role for Helicobacter pylori(H. pylori) infec-tion in pancreatic diseases remains controversial. H. pylori infection with antral predomination leading to an increase in pancreatic bicarbonate output and induc-ing ductal epithelial cell proliferation could contribute to the development of pancreatic cancer via complex interactions with the ABO genotype, dietary and smok-ing habits and N-nitrosamine exposure of the host. Although the individual study data available so far is inconsistent, several meta-analyses have reported an increased risk for pancreatic cancer among H. pylori seropositive individuals. It has been suggested that H. pylori causes autoimmune pancreatitis due to molecu-lar mimicry between H. pylori a-carbonic anhydrase(a-CA) and human CA type Ⅱ, and between H. pylori plasminogen-binding protein and human ubiquitin-protein ligase E3 component n-recognin 2, enzymes that are highly expressed in the pancreatic ductal andacinar cells, respectively. Future studies involving large numbers of cases are needed in order to examine the role of H. pylori in autoimmune pancreatitis more fully. Considering the worldwide pancreatic cancer burden, as well as the association between autoimmune pan-creatitis and other autoimmune conditions, a complete elucidation of the role played by H. pylori in the gen-esis of such conditions could have a substantial impact on healthcare.

Neoadjuvant peptide receptor radionuclide therapy for an inoperable neuroendocrine pancreatic tumor

Pancreatic endocrine tumors are rare but are among the most common neuroendocrine neoplasms of the abdomen.At diagnosis many of them are already advanced and diff icult to treat.We report on an initially inoperable malignant pancreatic endocrine tumor in a 33-year-old woman,who received neoadjuvant peptide receptor radionuclide therapy(PRRT)as firstline treatment.This resulted in a signif icant downstaging of the tumor and allowed its subsequent complete surgical removal.Follow-up for eighteen months revealed a complete remission.This is the first report on neoadjuvant PRRT in a neuroendocrine neoplasm with subsequent successful complete resection.

Spontaneous regression of pancreatic cancer: Real or a misdiagnosis?

Spontaneous tumor regression has been subject of numerous studies and speculations for many years. This phenomenon is exceptional, but well reported, in some types of tumors, but not in pancreatic cancer. Pancreatic cancer has the worst five-year survival rate of any cancer. Despite numerous molecular studies and clinical approaches, using several mouse models, this cancer responds poorly to the existing chemotherapeutic agents and progress on treatment remains elusive. Although pancreatic cancer tumors seldom undergo spontaneous regression, and some authors take that with skepticism, there are some cases reported in the literature. However, the variability in the description of the reports and technical details could make this process susceptible to misdiagnosis. Distinguishing between different types of pancreatic carcinoma should be taken with caution as they have wide differences in malignant potential. Diseases such as pancreatic benign tumors, insulinomas, or autoimmune pancreatitis could be responsible for this misdiagnosis as a pancreatic cancer. Here we review different cases reported, their clinical characteristics, and possible mechanisms leading to spontaneous regression of pancreatic cancer. We also discuss the possibilities of misdiagnosis.

THE SIGNIFICANCE OF PRE- AND POSTOPERATIVE MEASUREMENT OF SERUM CA242 LEVELS IN PANCREATIC CANCER

CA242 is a novel tumorassociated antigen, which has been suggested as a potential candidate for a serum tumor marker in pancreatic cancer[1.2], It may be useful because of its higher specificity[3]. The present study is a clinical evaluation of the value of serial measurements of CA242 levels in determining the size and the resectability in patients with pancreatic cancer. 26 patients (12 men and 14 women, average age: 54. 4 years) with histologically proven pancreatic cancer were studied. There was a significant positive correlation between the largest diameters and the serum levels of CA242 (P<0. 005). Serum levels of CA242 in 5 patients with resectable pancreatic cancer were significantly lower than those in 21patients with the unresectable (P <0.05), The serum CA242 levels in 5 patients who underwent resection of pancreatic cancers decreased sharply after resection (P <0.05). However, no significant changes of CA242 levels in 6 patients with the unresectable who underwent only biliary bypass were found after operation (PTh 0. 5). The CA242 tumor marker is sialylated carbohydrate antigen, which firstwas isolated in 1985 by Lindholm et al[4].A tumor marker ought to demonstrate in-creasing values if tumor load becomesgreater. Serial examinations of serum lev-els of CA242 in the patients with pacreaticcancer apparently reflect the tumor bur-den. The CA242 serum level provides auseful indicator for the effective treatmentof pancreatic cancer.

Safety and Feasibility of Oral Rehydration Solution Prior to Endoscopic Retrograde Cholangiopancreatography

Purpose: The safety of oral rehydration therapy before endoscopic screening with respect to vital signs and complications after the screening procedure was assessed in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). Methods: A total of 107 patients scheduled for ERCP were assigned to either the intravenous drip injection (DIV) group during fasting (56 patients) or ORS group given oral rehydration solution (51 patients) prior to endoscopy. Vital signs after ERCP, including blood pressure and temperature, blood biochemical data and the incidence of post-ERCP complications were compared between the groups. Results: No cases of aspiration pneumonia were detected in either groups. Moreover, there were no statistically significant differences between the DIV group and ORS group in terms of the biochemical data and vital signs after ERCP. The intergroup difference in the development of pancreatitis after ERCP was 2.3% [95% CI: ?5.7, 10.3], which was not statistically significant. Conclusions: The safety of oral rehydration therapy was found to be equivalent to that of the customary practice of infusion as a method for managing hydration and replenishing electrolytes in patients receiving ERCP. Oral rehydration therapy may be easily utilized as rehydration therapy prior to endoscopic screening for ERCP and other procedures.