Az endoszkópos retrográd cholangiopancreatographiát követő heveny hasnyálmirigy-gyulladás megelőzése

Abstract

Állomány-egészségtani és Állatorvosi Etológia Tanszék, BudapestMagyarországon az évente elvégzett több mint 14 000 endoszkópos retrográd cholangiopancreatographia következ-tében hozzávetőlegesen 1400 pancreatitis kialakulásával, ezen belül 10 beteg halálával kell számolni. A szerzők átte-kintik az endoszkópos retrográd cholangiopancreatographiát követő heveny hasnyálmirigy-gyulladás megelőzésére vonatkozó szakirodalmat, ismertetik saját tapasztalataikat. Utalnak a diagnosztikus endoszkópos retrográd cholangiopancreatographia háttérbe szorulására. Hangsúlyozzák a beavatkozás javallatának gondos mérlegelését, a kockázati tényezők elemzését. Fontosnak tartják a kanülálások számának csökkentését, a korai előmetszést, a nagy kockázatú betegekben a pancreasstent beültetését, az indometacin vagy a diclofenac alkalmazását és a megfelelő intravénás folyadékbevitelt. Orv. Hetil., 2015, 156(18), 715-719. Kulcsszavak: endoszkópos retrográd cholangiopancreatographia, szövődmények, post-ERCP-s pancreatitis, megelőzés Prevention of pancreatitis following endoscopic retrograde cholangiopancreatographyOver 14 000 endoscopic retrograde cholangiopancreatographies are performed in Hungary annually, and approximately 1400 patients are calculated to develop pancreatititis including 10 cases with lethal outcome. This article is aimed to review recent relevant literature and to present a practical guide based on the authors' own experience for the prevention of pancreatitis following endoscopic retrograde cholangiopancreatography. The authors emphasize the importance of careful consideration of indications, analysis of risk factors, avoiding unnecessary diagnostic intervention, a decrease of the attempts for cannulation, early precut, implantation of pancreatic stent in high risk patients, administration of rectal indomethacin or diclofenac and adequate intravenous fl uid replacement. Keywords: endoscopic retrograde cholangiopancreatography, complications, Post-ERCP pancreatitis, preventionPatai, Á., Patai, Á. V., Solymosi, N., Tulassay, Z., Herszényi, L. [Prevention of pancreatitis following endoscopic retrograde cholangiopancreatography]. Orv. Hetil., 2015, 156(18), 715-719.

What is impact of nonsteroidal anti-inflammatory drugs in the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: a meta-analysis of randomized controlled trials

“…Sample sizes ranged from 100 to 665, and the incidence rate of PEP varied from 2.24–16.43%. Diclofenac was used in eight studies [ 16 , 21 , 27 , 29 , 30 , 32 , 34 , 38 ], indomethacin in 9 studies [ 15 , 17 , 22 , 24 - 26 , 28 , 31 , 33 , 38 ], while valdecoxib [ 23 ], ketoprofen [ 37 ], naproxen [ 35 ], and celecoxib [ 36 ] were used in one study, respectively. NSAIDs were administered rectally in 14 studies [ 15 – 17 , 22 , 24 – 31 , 33 , 35 ], orally in two studies [ 36 , 38 ], intravenously in two studies [ 23 , 37 ], intramuscularly in two studies [ 21 , 32 ], and intramuscularly and rectally in one study [ 34 ].…”

“…Diclofenac was used in eight studies [ 16 , 21 , 27 , 29 , 30 , 32 , 34 , 38 ], indomethacin in 9 studies [ 15 , 17 , 22 , 24 - 26 , 28 , 31 , 33 , 38 ], while valdecoxib [ 23 ], ketoprofen [ 37 ], naproxen [ 35 ], and celecoxib [ 36 ] were used in one study, respectively. NSAIDs were administered rectally in 14 studies [ 15 – 17 , 22 , 24 – 31 , 33 , 35 ], orally in two studies [ 36 , 38 ], intravenously in two studies [ 23 , 37 ], intramuscularly in two studies [ 21 , 32 ], and intramuscularly and rectally in one study [ 34 ]. NSAIDs were administered pre-ERCP in 13 studies [ 17 , 21 , 23 , 24 , 26 , 28 , 30 , 31 , 33 – 38 ], post-ERCP in six studies [ 16 , 22 , 25 , 27 , 29 , 32 ], during ERCP in one study [ 15 ], and pre-ERCP combined with post-ERCP in one study [ 38 ].…”

“…NSAIDs were administered rectally in 14 studies [ 15 – 17 , 22 , 24 – 31 , 33 , 35 ], orally in two studies [ 36 , 38 ], intravenously in two studies [ 23 , 37 ], intramuscularly in two studies [ 21 , 32 ], and intramuscularly and rectally in one study [ 34 ]. NSAIDs were administered pre-ERCP in 13 studies [ 17 , 21 , 23 , 24 , 26 , 28 , 30 , 31 , 33 – 38 ], post-ERCP in six studies [ 16 , 22 , 25 , 27 , 29 , 32 ], during ERCP in one study [ 15 ], and pre-ERCP combined with post-ERCP in one study [ 38 ]. Six studies evaluated only patients at high-risk for developing PEP [ 16 , 22 , 25 , 27 , 29 , 38 ], whereas 15 studies evaluated patients at average-risk for developing PEP [ 15 , 17 , 21 , 23 , 24 , 26 – 28 , 30 – 36 ].…”

“…Further analysis showed that the effect of indomethacin on the prevention of PEP was not different between average-risk and high-risk patients. In the meta-analysis of Inamdar et al, the authors suggest that indomethacin is effective in high-risk patients and may not be effective for average-risk patients, but only eight studies were included in the analysis, and the authors believe that the study of Patai et al [ 31 ]. was for high-risk populations [ 49 ].…”