Epinephrine irrigation for the prevention of pancreatic damage after endoscopic balloon sphincteroplasty

Ohashi, Akiyoshi; Tamada, Kiichi; Tomiyama, Takeshi; Wada, Shinichi; Higashizawa, Toshihiko; Gotoh, Yasuhiko; Satoh, Yasuyuki; Miyata, Takamitsu; Tano, Shigeo; Ido, Kenichi; Sugano, Kentaro

doi:10.1046/j.1440-1746.2001.02483.x

Cited by 31 publications

(25 citation statements)

References 16 publications

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“…Based on this theory, treatments aiming at decreasing the pressure in sphincter of Oddi have been started for reducing the post-ERCP pancreatitis risk. Recently, although nifedipine, glyceryl trinitrate (GTN), topical epinephrine or botulinum toxin have been used for this purpose, the results appear to be contradictory with each other (17)(18)(19)(20)(21)(22). GTN, the most promising one among those, is a rapid-acting short-standing nitric oxide source that considerably decreases the sphincter of Oddi pressure, which is used in cardiovascular diseases.…”

Section: Discussionmentioning

confidence: 99%

The effects of different mechanisms on the development of post-ERCP pancreatitis in an ERCP model in rats

Bozkurt

Güner²,

Kadıoğlu³

et al. 2013

Turk J Gastroenterol

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Section: Discussionmentioning

confidence: 99%

The effects of different mechanisms on the development of post-ERCP pancreatitis in an ERCP model in rats

Bozkurt

Güner²,

Kadıoğlu³

et al. 2013

Turk J Gastroenterol

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“…Subsequent two meta-analyses of 10 RCTs (1554 patients and 1730 patients respectively) have concluded that allopurinol does not reduce post-ERCP pancreatitis and should be not recommended as a prophylactic agent [63,64] . Other agents studied (Adrenaline spray, pentoxifylline, platelet-activating factor acetylhidrolase, semapimod, aprepitant and risperidone) have either revealed discordant results or no effect on preventing post-ERCP pancreatitis [64][65][66][67][68][69][70][71][72][73] .…”

Section: Interruption Of Inflammatory Cascade (Anti-inflammatory): Nomentioning

confidence: 99%

Prevention of post-ERCP pancreatitis

Wong

Tsai

2014

WJGP

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Post-procedure pancreatitis is the most common complication of endoscopic retrograde cholangio pancreatography (ERCP) and carries a high morbidity and mortality occurring in at least 3%-5% of all procedures. We reviewed the available literature searching for "ERCP" and "pancreatitis" and "post-ERCP pancreatitis". in PubMed and Medline. This review looks at the diagnosis, risk factors, causes and methods of preventing post-procedure pancreatitis. These include the evidence for patient selection, endoscopic techniques and pharmacological prophylaxis of ERCP induced pancreatitis. Selecting the right patient for the procedure by a risk benefits assessment is the best way of avoiding unnecessary ERCPs. Risk is particularly high in young women with sphincter of Oddi dysfunction (SOD). Many of the trials reviewed have rather few numbers of subjects and hence difficult to appraise. Meta-analyses have helped screen for promising modalities of prophylaxis. At present, evidence is emerging that pancreatic stenting of patients with SOD and rectally administered nonsteroidal anti-inflammatory drugs in a large unselected trial reduce the risk of post-procedure pancreatitis. A recent meta-analysis have demonstrated that rectally administered indomethecin, just before or after ERCP is associated with significantly lower rate of pancreatitis compared with placebo [OR = 0.49 (0.34-0.71); P = 0.0002]. Number needed to treat was 20. It is likely that one of these prophylactic measures will begin to be increasingly practised in high risk groups.© 2014 Baishideng Publishing Group Co., Limited. All rights reserved. Key words: Acute pancreatitis; Endoscopic retrograde cholangio pancreatographyCore tip: Select patients carefully, and give high risk patients rectal indomethacin.Wong LL, Tsai HH. Prevention of post-ERCP pancreatitis.

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“…Gabexate mesylate may reduce the incidence of especially moderate or severe pancreatitis. 41 Insertion of a pancreatic stent, 42 epinephrine irrigation after EPBD, 43 isosorbide dinitrate infusion, 44 and injection of botulinum toxin to lower the pancreatic sphincter pressure 45 may augment pancreatic drainage. However these adjuvant interventions also present potential for complications, and their time or cost-effectiveness remains questionable.…”

Section: Complications 1) Post-epbd Pancreatitismentioning

confidence: 99%

Endoscopic Papillary Balloon Dilation for Removal of Choledocholithiasis: Indications, Advantages, Complications, and Long-Term Follow-Up Results

Chung¹,

Chung²

2011

Gut Liver

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Endoscopic papillary balloon dilation (EPBD) is an alternative method of endoscopic sphincterotomy (EST). Although concerns regarding post-procedure pancreatitis have been expressed, EPBD has come to be recognized as an effective and safe method for stone removal in specific cases. To analyze the proper indications, ideal methods, complications, and long-term follow-up results for EPBD, we reviewed articles about EPBD located through a search of the PubMed data base. We analyzed the ballooning methods, indications, results and complications of EPBD among the articles found and compared the results with those of EST. We considered the authors' own clinical experience and knowledge in developing recommendations for EPBD. EPBD showed similar effi cacy and safety for the removal of choledocholithiasis to that of EST. Although large or multiple stones were diffi cult to remove by EPBD, it was safer and easier to apply in patients with coagulopathy or abnormal anatomy. To prevent severe pancreatitis, excessive ballooning and impractical cannulation should be avoided, and precut sphincterotomy or adjuvant prophylaxis should be considered. Due to its preservation of the sphincter of Oddi, EPBD is expected to have fewer long-term complications, such as stone recurrence, cholangitis and cholecystitis. In conclusion, EPBD appears to be safe and effective for the treatment of choledocholithiasis with proper selection of ballooning methods and patients. (Gut Liver 2011;5:1-14)

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Epinephrine irrigation for the prevention of pancreatic damage after endoscopic balloon sphincteroplasty

Abstract: Epinephrine irrigation is a simple and useful method to prevent post-EBS pancreatic damage and pancreatitis.

Cited by 31 publications

References 16 publications

The effects of different mechanisms on the development of post-ERCP pancreatitis in an ERCP model in rats

The effects of different mechanisms on the development of post-ERCP pancreatitis in an ERCP model in rats

Prevention of post-ERCP pancreatitis

Endoscopic Papillary Balloon Dilation for Removal of Choledocholithiasis: Indications, Advantages, Complications, and Long-Term Follow-Up Results

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