Application Value of Nursing Intervention for Patients with Pancreatitis After Endoscopic Retrograde Cholangiopancreatography(ERCP)

Objective:To explore and analyze the application value of nursing intervention for patients with pancreatitis after endoscopic retrograde cholangiopancreatography(ERCP).Methods:From May 2022 to May 2023,100 patients with pancreatitis after ERCP who were admitted to the General Surgery Department of our hospital were selected as the research objects,they were divided into a research group and a general group by flipping coins,with 50 cases in each group.The research group received nursing intervention,and the general group received general nursing.The postoperative index recovery time,quality of life,and emotional performance were compared between the two groups.Results:The blood amylase recovery time,abdominal pain recovery time,white blood cell recovery time,and hospitalization time in the research group were significantly lower than those in the general group(P<0.05).Before intervention,the physical function,social factors,physiological performance,emotional state,and other quality of life indicators were compared between the groups,and there was no statistically significant difference(P>0.05);after intervention,the mentioned quality of life indicators were significantly better than that of the general group(P<0.05).Before intervention,the Self-Rating Anxiety Scale(SAS)and Self-Rating Depression Scale(SDS)scores between the groups were compared,and there was no statistically significant difference(P>0.05);after intervention,the SAS and SDS scores of the research group were significantly better than those of the general group(P<0.05).Conclusion:The application of nursing intervention in patients with pancreatitis after ERCP has high clinical value and specific practical significance.

Clinical usefulness and current problems of pancreatic duct stenting for preventing post-ERCP pancreatitis

Endoscopic retrograde cholangiopancreatography(ERCP) is an endoscopic procedure with high frequency of accidental symptoms, and particularly some patients who develop and aggravate pancreatitis due to the procedure may need treatment of surgery or die. Various attempts were performed so far to prevent post-ERCP pancreatitis, however, it is impossible to completely prevent pancreatitis at this time because there are various factors for occurrence of post-ERCP pancreatitis.One of the most frequent causes of post-ERCP pancreatitis is considered to be congestion of pancreatic juice associated with duodenal papilledema after examination or treatment. Recently it is often reported that use of a pancreatic duct stent may prevent occurrence of pancreatitis which occurs because of an increased inner pressure of the pancreatic duct caused by congestion of pancreatic juice associated with duodenal papilledema. However, there are some patients who develop pancreatitis even if treated with the pancreatic duct stent, thus further clarification of the pathology and advancement of the prophylactic method will be needed.

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.

N-acetylcysteine does not prevent post-endoscopic retrograde cholangiopancreatography hyperamylasemia and acute pancreatitis

AIM： Acute pancreatitis （AP） is the most common and often severe complication of endoscopic retrograde cholangiopancreatography （ERCP）. The early step in the pathogenesis of acute pancreatitis is probably the capillary endothelial injury mediated by oxygen-derived free radicals. N-acetylcysteine - a free radical scavenger may be potentially effective in preventing post-ERCP acute pancreatitis and it is also known that N-acetylcysteine （ACC） can reduce the severity of disease in experimental model of AP. METHODS： One hundred and six patients were randomly allocated to two groups. Fifty-five patients were given N-acetylcysteine （two 600 mg doses orally 24 and 12 h before ERCP and 600 mg was given iv, twice a day for two days after the ERCP）. The control group consisted of 51 patients who were given iv. isotonic saline twice a day for two days after the ERCP. Serum and urine amylase activities were measured before ERCP and 8 and 24 h after the procedure. The primary outcome parameter was post-ERCP acute pancreatitis and the secondary outcome parameters were differences between groups in serum and urine amylase activity. RESULTS： There were no significant differences in the rate of post-ERCP pancreatitis between two groups （10 patients overall, 4 in the ACC group and 6 in the controlgroup）. There were also no significant differences in baseline and post-ERCP serum and urine amylase activity between ACC group and control group. CONCLUSION： N-acetylcysteine fails to demonstrate any significant preventive effect on post-ERCP pancreatitis, as well as on serum and urine amylase activity.

Analysis of the risk factors for severity in post endoscopic retrograde cholangiopancreatography pancreatitis: The indication of prophylactic treatments

To determine the risk factors of severe post endoscopic retrograde cholangiopancreatography pancreatitis (sPEP) and clarify the indication of prophylactic treatments. METHODSAt our hospital, endoscopic retrograde cholangiopancreatography (ERCP) was performed on 1507 patients from May 2012 to December 2015. Of these patients, we enrolled all 121 patients that were diagnosed with post endoscopic retrograde PEP. Fourteen of 121 patients diagnosed as sPEP were analyzed. RESULTSForty-one patients had contrast media remaining in the pancreatic duct after completion of ERCP. Seventy-one patients had abdominal pain within three hours after ERCP. These were significant differences for sPEP (P < 0.05). The median of Body mass index, the median time for ERCP, the median serum amylase level of the next day, past histories including drinking and smoking, past history of pancreatitis, sphincter of Oddi dysfunction, whether emergency or not, expertise of ERCP procedure, diverticulum nearby Vater papilla, whether there was sphincterotomy or papillary balloon dilation, pancreatic duct cannulation, use of intra-ductal ultrasonography enforcement, and transpapillary biopsies had no significant differences with sPEP. CONCLUSIONContrast media remaining in the pancreatic duct and the appearance of abdominal pain within three hours after ERCP were risk factors of sPEP.

Pancreatic stents for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis should be inserted up to the pancreatic body or tail

AIM To investigate the location to which a pancreatic stent should be inserted to prevent post-endoscopic retrograde cholangiopancreatography(ERCP) pancreatitis(PEP).METHODS Over a ten-year period at our hospital, 296 patients underwent their first ERCP procedure and had a pancreatic stent inserted; this study included 147 patients who had ERCP performed primarily for biliary investigation and had a pancreatic stent inserted to prevent PEP. We dividedthese patients into two groups: 131 patients with a stent inserted into the pancreatic head(head group) and 16 patients with a stent inserted up to the pancreatic body or tail(body/tail group). Patient characteristics and ERCP factors were compared between the groups.RESULTS Pancreatic amylase isoenzyme(p-AMY) levels in the head group were significantly higher than those in the body/tail group [138.5(7.0-2086) vs 78.5(5.0-1266.5), P = 0.03] [median(range)]. No cases of PEP were detected in the body/tail group [head group, 12(9.2%)]. Of the risk factors for post-ERCP hyperamylasemia(≥ p-AMY median, 131 IU/L), procedure time ≥ 60 min [odds ratio(OR) 2.65, 95%CI: 1.17-6.02, P = 0.02) and stent insertion into the pancreatic head(OR 3.80, 95%CI: 1.12-12.9, P = 0.03) were identified as independent risk factors by multivariate analysis.CONCLUSION Stent insertion up to the pancreatic body or tail reduces the risk of post-ERCP hyperamylasemia and may reduce the risk of PEP.

Updated meta-analysis of pancreatic stent placement in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis

AIM: To investigate the efficacy and safety profile ofpancreatic duct(PD) stent placement for prevention of post-endoscopic retrograde cholangiopancreatography(ERCP) pancreatitis(PEP). METHODS: We performed a search of MEDLINE, EMBASE, and Cochrane Library to identify randomized controlled clinical trials of prophylactic PD stent placement after ERCP. Rev Man 5 software provided by Cochrane was used for the heterogeneity and efficacy analyses, and a meta-analysis was performed for the data that showed homogeneity. Categorical data are presented as relative risks and 95% confidence intervals(CIs), and measurement data are presented as weighted mean differences and 95%CIs. RESULTS: The incidence rates of severe pancreatitis, operation failure, complications and patient pain severity were analyzed. Data on pancreatitis incidence were reported in 14 of 15 trials. There was no significant heterogeneity between the trials(I2 = 0%, P = 0.93). In the stent group, 49 of the 1233 patients suffered from PEP, compared to 133 of the 1277 patients in the no-stent group. The results of this meta-analysis indicate that it may be possible to prevent PEP by placing a PD stent. CONCLUSION: PD stent placement can reduce postoperative hyperamylasemia and might be an effective and safe option to prevent PEP if the operation indications are well controlled.

Prophecy about post-endoscopic retrograde cholangiopancreatography pancreatitis:From divination to science

One unresolved issue of endoscopic retrograde cholangiopancreatography(ERCP)is post-ERCP pancreatitis (PEP),which occurs in up to 40%of patients.Identification of risk factors for PEP is especially important in the field of ERCP practice because it may assist physicians in taking protective measures in situations with high risk.A decade ago,Freeman et al meticulously evaluated a large number of potentially relevant risk factors for PEP,which can be divided into patient-relat-ed and procedure-related issues.In this commentary, we summarize this classic article and reevaluate the risk factors for PEP from the current point of view.This is followed by assessment of strategies for prevention of PEP that can be divided into mechanical and pharmacologic methods.

Antioxidant therapy in acute,chronic and post-endoscopic retrograde cholangiopancreatography pancreatitis:An updated systematic review and meta-analysis

AIM:To investigate the efficacy and adverse effects of antioxidant therapy in acute pancreatitis(AP),chronic pancreatitis(CP) and post-endoscopic retrograde cholangiopancreatography pancreatitis(PEP).METHODS:Pub Med,Scopus,Google Scholar,Cochrane library database,and Evidence-based medicine/clinical trials published before August 2014 were searched. Clinical and laboratory outcomes of randomized trials of antioxidant therapy in patients with AP,CP and PEP were included. The methodological quality of the trials was assessed by the Jadad score based on the description of randomization,blinding,and dropouts(withdrawals). The results of the studies were pooled and meta-analyzed to provide estimates of the efficacy of antioxidant therapy.RESULTS:Thirty four trials out of 1069 potentially relevant studies with data for 4898 patients wereeligible for inclusion. Antioxidant therapy significantly reduced the length of hospital stay in AP patients {mean difference-2.59 d(95%CI:-4.25-(-0.93)],P = 0.002}. Although,antioxidant therapy had no significant effect on serum C reactive protein(CRP) after 5-7 d in AP patients [mean difference-9.57(95%CI:-40.61-21.48,P = 0.55],it significantly reduced serum CRP after 10 d {mean difference-45.16 [95%CI:-89.99-(-0.33)],P = 0.048}. In addition,antioxidant therapy had no significant effect on CP-induced pain [mean difference-2.13(95%CI:-5.87-1.6),P = 0.26]. Antioxidant therapy had no significant effects on the incidence of all types of PEP [mean difference 1.05(95%CI:0.74-1.5),P = 0.78],severe PEP [mean difference 0.92(95%CI:0.43-1.97),P = 0.83],moderate PEP [mean difference 0.82(95%CI:0.54-1.23),P = 0.33],and mild PEP [mean difference 1.33(95%CI:0.99-1.78),P = 0.06]. Furthermore,while antioxidant therapy had no significant effect on serum amylase after less than 8 h sampling [mean difference-20.61(95%CI:-143.61-102.39),P = 0.74],it significantly reduced serum amylase close to 24-h sampling {mean difference-16.13 [95%CI:-22.98-(-9.28)],P < 0.0001}.CONCLUSION:While there is some evidence to support antioxidant therapy in AP,its effect on CP and PEP is still controversial.

Prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis by pancreatic duct stenting using a loop-tipped guidewire

AIM: To examine whether it is possible to prevent the occurrence of post-endoscopic retrograde cholangiopancreatography(ERCP) pancreatitis in patients experiencing difficulties with selective biliary duct cannulation by pancreatic duct stenting using a looptipped guidewire.METHODS: Procedure success rate, frequency of unintended insertion of the guidewire into side branches of the pancreatic duct, and incidence of procedural accidents were examined using a loop-tipped guidewire(Group A, 20 patients), and a conventional straighttype guidewire(Group B, 20 patients).RESULTS: The success rate of the procedure was 100% in both groups. Unintended insertion of the guidewire into a side branch of the pancreatic duct occurred 0.056 ± 0.23(0-1) times in Group A and 2.3 ±1.84(0-5) times in Group B; thus, unintended insertion of the guidewire into a side branch of the pancreatic duct was seen significantly less frequently in Group A. There were no procedural accidents in Group A, whereas pancreatitis occurred in one Group B patient; however, the difference between the two groups was not statistically significant. The serum amylase level after ERCP was 257.15 ± 136.4(88-628) IU/L in Group A, and 552.05 ± 534.57(101-2389) IU/L in Group B, showing a significantly lower value in Group A. Hyperamylasemia was found in two patients(10%) in Group A, and nine(45%) in Group B, showing a significantly lower value in Group A.CONCLUSION: The results suggest that in patients who experience difficulties with biliary cannulation, the use of a loop-tipped guidewire for pancreatic duct stenting may assist with the prevention of post-ERCP pancreatitis, and thereby to a reduction of the risk of post-ERCP pancreatitis or hyperamylasemia.

Usefulness of serum lipase for early diagnosis of post-endoscopic retrograde cholangiopancreatography pancreatitis

BACKGROUND Post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis(PEP)is new onset acute pancreatitis after ERCP.This complication is sometimes fatal.As such,PEP should be diagnosed early so that therapeutic interventions can be carried out.Serum lipase(s-Lip)is useful for diagnosing acute pancreatitis.However,its usefulness for diagnosing PEP has not been sufficiently investigated.AIM This study aimed to retrospectively examine the usefulness of s-Lip for the early diagnosis of PEP.METHODS We retrospectively examined 4192 patients who underwent ERCP at our two hospitals over the last 5 years.The primary outcomes were a comparison of the areas under the receiver operating characteristic(ROC)curves(AUCs)of s-Lip and serum amylase(s-Amy),s-Lip and s-Amy cutoff values based on the presence or absence of PEP in the early stage after ERCP via ROC curves,and the diagnostic properties[sensitivities,specificities,positive predictive values(PPV),and negative predictive value(NPV)]of these cutoff values for PEP diagnosis.RESULTS Based on the eligibility and exclusion criteria,804 cases were registered.Over the entire course,PEP occurred in 78 patients(9.7%).It occurred in the early stage after ERCP in 40 patients(51.3%)and in the late stage after ERCP in 38 patients(48.7%).The AUCs were 0.908 for s-Lip[95%confidence interval(CI):0.880-0.940,P<0.001]and 0.880 for s-Amy(95%CI:0.846-0.915,P<0.001),indicating both are useful for early diagnosis.By comparing the AUCs,s-Lip was found to be significantly more useful for the early diagnosis of PEP than s-Amy(P=0.023).The optimal cutoff values calculated from the ROC curves were 342 U/L for s-Lip(sensitivity,0.859;specificity,0.867;PPV,0.405;NPV,0.981)and 171 U/L for s-Amy(sensitivity,0.859;specificity,0.763;PPV,0.277;NPV,0.979).CONCLUSION S-Lip was significantly more useful for the early diagnosis of PEP.Measuring s-Lip after ERCP could help diagnose PEP earlier;hence,therapeutic interventions can be provided earlier.

Suppository naproxen reduces incidence and severity of post-endoscopic retrograde cholangiopancreatography pancreatitis: Randomized controlled trial

AIM: To determine the efficacy of rectally administered naproxen for the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP).METHODS: This double-blind randomized control trial conducted from January 2013 to April 2014 at the Gastrointestinal and Liver Diseases Research Center in Rasht, Iran. A total of 324 patients were selected from candidates for diagnostic or therapeutic ERCP by using the simple sampling method. Patients received a single dose of Naproxen (500 mg; n = 162) or a placebo (n = 162) per rectum immediately before ERCP. The overall incidence of PEP, incidence of mild to severe PEP, serum amylase levels and adverse effects were measured. The primary outcome measure was the development of pancreatitis onset of pain in the upper abdomen and elevation of the serum amylase level to &#x0003e; 3 &#x000d7; the upper normal limit (60-100 IU/L) within 24 h after ERCP. The severity of PEP was classified according to the duration of therapeutic intervention for PEP: mild, 2-3 d; moderate 4-10 d; and severe, &#x0003e; 10 d and/or necessitated surgical or intensive treatment, or contributed to death.RESULTS: PEP occurred in 12% (40/324) of participants, and was significantly more frequent in the placebo group compared to the naproxen group (P &#x0003c; 0.01). Of the participants, 25.9% (84/324) developed hyperamylasemia within 2 h of procedure completion, among whom only 35 cases belonged to the naproxen group (P &#x0003c; 0.01). The incidence of PEP was significantly higher in female sex, in patients receiving pancreatic duct injection, more than 3 times pancreatic duct cannulations, and ERCP duration more than 40 min (Ps &#x0003c; 0.01). There were no statistically significant differences between the groups regarding the procedures or factors that might increase the risk of PEP, sphincterotomy, precut requirement, biliary duct injection and number of pancreatic duct cannulations. In the subgroup of patients with pancreatic duct injection, the rate of pancreatitis in the naproxen group was significantly lower than that in the placebo (6 patients vs 23 patients, P &#x0003c; 0.01, RRR = 12%, AR = 0.3, 95%CI: 0.2-0.6). Naproxen reduced the PEP in patients with &#x02265; 3 pancreatic cannulations (P &#x0003c; 0.01, RRR = 25%, AR = 0.1, 95%CI: 0.1-0.4) and an ERCP duration &#x0003e; 40 min (P &#x0003c; 0.01, RRR = 20%, AR = 0.9, 95%CI: 0.4-1.2).CONCLUSION: Single dose of suppository naproxen administered immediately before ERCP reduces the incidence of PEP.

Combination of two-hour post-endoscopic retrograde cholangiopancreatography amylase levels and cannulation times is useful for predicting post-endoscopic retrograde cholangiopancreatography pancreatitis

AIM To estimate the efficacy of 2 h post-endoscopic retrograde cholangiopancreatography(ERCP) serum amylase levels and other factors for predicting postERCP pancreatitis.METHODS This was a retrospective,single-center cohort study of consecutive patients who underwent ERCP from January 2010 to December 2013.Serum amylase levels were measured 2 h post-procedure,and patient- and procedure-related pancreatitis(PEP) risk factors wereanalyzed using a logistic model.RESULTS A total of 1520 cases(average age 72 ± 12 years,60% male) were initially enrolled in this study,and 1403 cases(725 patients) were ultimately analyzed after the exclusion of 117 cases.Fifty-five of these cases developed PEP.We established a 2 h serum amylase cutoff level of two times the upper limit of normal for predicting PEP.Multivariate analysis revealed that a cannulation time of more than 13 min [odds ratio(OR) 2.28,95%CI:1.132-4.651,P=0.0210] and 2 h amylase levels greater than the cutoff level(OR=24.1,95%CI:11.56-57.13,P<0.0001) were significant predictive factors for PEP.Forty-seven of the 55 patients who developed PEP exhibited 2 h amylase levels greater than the cutoff level(85%),and six of the remaining eight patients who developed PEP(75%) required longer cannulation times.Only 2 of the 1403 patients(0.14%) who developed PEP did not exhibit concerning 2 h amylase levels or require longer cannulation times.CONCLUSION These findings indicate that the combination of 2 h post-ERCP serum amylase levels and cannulation times represents a valuable marker for identifying patients at high risk for PEP.

Risk factors for the development of post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with asymptomatic common bile duct stones

BACKGROUND Previous studies have revealed that patients with asymptomatic common bile duct(CBD)stones are at a high risk of developing post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis(PEP).However,no studies to date have addressed the risk factors for PEP in patients with asymptomatic CBD stones.AIM To examine the risk factors for PEP in patients with asymptomatic CBD stones.METHODS Using medical records of three institutions in Japan for 6 years,we identified a total of 1135 patients with choledocholithiasis including 967 symptomatic patients and 168 asymptomatic patients with native papilla who underwent therapeutic ERCP.We performed univariate and multivariate analyses to examine the risk factors for PEP in the 168 patients with asymptomatic CBD stones.RESULTS The overall incidence rate of PEP in all the patients with during study period was 4.7%(53/1135).Of the 168 patients with asymptomatic CBD stones,24(14.3%)developed PEP.In univariate analysis,precut sphincterotomy(P=0.009)and biliary balloon sphincter dilation(P=0.043)were significant risk factors for PEP.In multivariate analysis,precut sphincterotomy(P=0.002,95%CI:2.2-27.8,odds ratio=7.7),biliary balloon sphincter dilation(P=0.015,95%CI:1.4-17.3,odds ratio=4.9),and trainee endoscopists(P=0.048,95%CI:1.01-8.1,odds ratio=2.9)were significant risk factors for PEP.CONCLUSION ERCP for asymptomatic CBD stones should be performed by experienced endoscopists.When performing precut sphincterotomy or biliary balloon sphincter dilation in patients with asymptomatic CBD stones,the placement of a prophylactic pancreatic stent is strongly recommended to prevent PEP.

Pancreatic stents to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis: A meta-analysis

BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)plays a major role in the investigation and treatment of pancreaticobiliary diseases.However,post-ERCP pancreatitis(PEP)is a severe adverse effect.Prior meta-analyses have shown that prophylactic PS was useful for preventing PEP.However,abstract reports and patients who underwent endoscopic ampullectomy were included in the previous analyses.In addition,two meta-analyses involved non-randomized controlled trials(RCTs).The efficacy of PS for preventing severe PEP was different in each meta-analysis.Therefore,we performed the current metaanalysis,which included only full-text articles,and added new findings.AIM To reveal the efficacy of prophylactic pancreatic stent(PS)placement for preventing PEP.METHODS We searched the MEDLINE,Cochrane Library and PubMed databases for related RCTs.Among the reports retrieved,11 studies were included in this metaanalysis.All full-text articles were published between 1993 and 2016.A total of 1475 patients were enrolled in the included studies;of these patients,734 had a PS inserted,and 741 did not have a PS inserted.PEP and severe PEP occurrence were evaluated in this meta-analysis.RESULTS PEP was observed in all studies and occurred in 39(5.3%)patients who received a PS.On the other hand,PEP occurred in 141(19%)patients who did not receive a PS.The occurrence of PEP was significantly lower in the patients who underwent PS placement than in the patients who did not receive a PS(OR=0.32;95%CI:0.23-0.45;P<0.001).In addition,the occurrence of severe PEP was evaluated.Notably,the occurrence of severe PEP was not observed in the stent group;however,the occurrence of severe PEP was observed in 8(1.3%)patients who did not have a PS inserted.Severe PEP occurred significantly less often in the stent group than in the no stent group(OR=0.24;95%CI:0.06-0.94;P=0.04).CONCLUSION In conclusion,prophylactic PS placement is useful for preventing PEP and severe PEP.

Early immune response in post endoscopic retrograde cholangiopancreatography pancreatitis as a model for acute pancreatitis

This opinion review summarizes comparison of clinical presentation and immunology of post-endoscopic pancreatitis and acute pancreatitis(AP) of other etiology.The rationale for this topic was found in studies that mention differences in clinical presentation between these entities,stating that severe form of AP after endoscopic retrograde cholangiopancreatography was more severe than AP of other etiology.Found difference in clinical presentation may have a background in different immunology that needs to be further investigated.

血清脂肪酶在ERCP术后胰腺炎早期诊断中的价值

目的探讨血清脂肪酶在经内镜逆行胰胆管造影(ERCP)术后胰腺炎早期诊断中的价值.方法回顾性分析2017-03至2020-03武警重庆总队医院普外科和陆军军医大学第一附属医院住院肝胆胰微创外科中心行ERCP手术治疗的患者3190例,分别比较血清脂肪酶和淀粉酶ROC曲线下AUC面积、术后早期是否发生胰腺炎的ROC曲线界值点和该数值的ERCP术后胰腺炎(PEP)早期诊断属性(敏感性、特异性、阳性预测值和阴性预测值).结果纳入研究的802例病例中,ER-CP术后胰腺炎共发生56例,占总例数6.9%,其中ERCP术后3 h发生胰腺炎30例(53.6%),ERCP术后24 h发生胰腺炎26例(46.4%).ERCP术后3 h血清脂肪酶AUC面积为0.93(95%可信区间为0.80~0.96),血清淀粉酶AUC面积为0.87(95%可信区间0.78~0.90),其差异具有统计学意义(P<0.01).ROC曲线显示血清脂肪酶的最佳界点值为382 U/L,其敏感度88.0%,特异性89.0%,阳性预测值0.50,阴性预测值0.98;血清淀粉酶的最佳切点值228U/L,其敏感度82.0%,特异度78.0%,阳性预测值0.36,阴性预测值0.97.结论血清脂肪酶在早期诊断PEP中有较高敏感度和特异度,其在ERCP术后早期检测值为PEP的早期干预提供重要依据.

Use of the urinary trypsinogen-2 dipstick test in early diagnosis of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP)

Background: Acute pancreatitis is one of the most serious complications of ERCP. Early diagnosis of post ERCP pancreatitis helps physicians to provide intensive care and possible medical treatment as early as possible. Trypsinogen-2 in urine is a good diagnostic and prognostic marker of acute pancreatitis. Objectives: To evaluate the diagnostic value of urinary trypsinogen-2 dipstick test for early diagnosis of post ERCP pancreatitis. Methods: A total of 37 patients with obstructive jaundice were tested with the urinary trypsinogen-2 dipstick test and serum levels of amylase and lipase before ERCP and 6 hours after ERCP. Results: Post ERCP pancreatitis was diagnosed in 6 (16%) of 37 patients. The sensitivity, specificity, positive predictive value and negative predictive value of urinary trypsinogen-2 dipstick test at 6 hours after ERCP were 100%, 97%, 86%, 100% respectively. At the cutoff level (130 U/L) for lipase, the positive predictive value and negative predictive value all were (100%), however, the positive predictive value and negative predictive value for amylase levels at cutoff (122 U/L) were 60%, 100% respectively. Serum lipase level was the best test for diagnosing post ERCP pancreatitis followed by the urinary trypsinogen-2 dipstick test. Conclusions: The urinary trypsinogen-2 dipstick test can be used as a rapid and easy test for early diagnosis of post ERCP pancreatitis with high sensitivity and specificity.

生长抑素联合内镜下鼻胆管引流术在胆总管结石行ERCP术中的效果分析

目的探讨生长抑素联合内镜下鼻胆管引流术(ENBD)在胆总管结石行ERCP术中的应用价值。方法选取2021年1月至2022年12月在安徽医科大学附属安庆第一人民医院龙山院区肝胆外科行ERCP治疗的150例胆总管结石患者为研究对象,按照治疗方式不同分成3组:生长抑素组50例、吲哚美辛组50例、生长抑素联合ENBD组50例。比较3组患者ERCP术后胰腺炎(PEP)及高淀粉酶血症的发生率,并发症发生率,术后3h、24h、48h谷丙转氨酶、谷草转氨酶、血淀粉酶、白细胞变化情况,以及术后术后视觉模拟评分法(VAS)疼痛评分、术后住院时间、术后费用。结果生长抑素联合ENBD组术后3h、24h、48h高淀粉酶血症、PEP、并发症发生率以及住院时间低于生长抑素组和吲哚美辛组,差异有统计学意义(P<0.05)。3组患者术后3hVAS疼痛评分比较,差异无统计学差异(P>0.05),术后24h、48hVAS疼痛评分生长抑素联合ENBD组低于生长抑素组和吲哚美辛组,差异有统计学意义(P<0.05)。生长抑素联合ENBD组术后费用高于生长抑素组和吲哚美辛组,差异有统计学意义(P<0.05)。术后3h、24h、48h白细胞数值、谷草转氨酶、谷丙转氨酶相比较,3组间差异无统计学意义(P>0.05)。结论相较于生吲哚美辛以及生长抑素单药,生长抑素联合ENBD能够有效降低胆总管结石行ERCP术后胰腺炎及高淀粉酶血症的发生率,并能减少患者住院时间,患者能够从中获益。

Prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis using pancreatic stents: A review of efficacy, diameter and length

Although endoscopic retrograde cholangiopancreatography (ERCP) is an important procedure for the diagnosis and treatment of pancreaticobiliary diseases, post-ERCP pancreatitis (PEP) is the most frequent adverse event that can sometimes be fatal. However, prophylactic pancreatic stent (PS) insertion has been performed to prevent PEP in high-risk patients. In some randomized controlled trials (RCTs) and meta-analyses, the efficacy of prophylactic PS insertion has been shown to prevent PEP. In addition, several types of stents have been used to decrease PEP. In this review, we introduce the details of these RCTs and meta-analyses and reveal the specifications for stent placement, for example, the stent diameter and length and the pancreatic region into which the stent should be inserted.