Mechanism of pancreatitis caused by ERCP

Akashi, Ryukichi; Kiyozumi, Takeaki; Tanaka, Tomofumi; Sakurai, Katsunobu; Oda, Yasushi; Sagara, Kouichi

doi:10.1067/mge.2002.118964

Cited by 77 publications

(59 citation statements)

References 21 publications

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“…In experimental models of acute pancreatitis, it has been suggested that digestive enzyme activation might occur within acinar cells. This has been shown in the early stages of acute pancreatitis induced by secretagogues or by diet [7] . There is co-localization of digestive enzymes and lysosomal hydrolases within large cytoplasm vacuoles [8] .…”

Section: Pathogenesismentioning

confidence: 81%

“…Performance of biliary sphincterotomy for biliary stones or malignant biliary obstruction has not been associated with significant added independent risk of pancreatitis in most largescale prospective multivariate analyses [11,24,25] . This was highlighted by a Japanese group [7] , who showed that, although the frequency of biliary ES-induced pancreatitis was significantly higher than that of diagnostic PEP, the frequency of severe pancreatitis at 48-72 h was significantly lower within the group of patients who had undergone biliary ES. It is thought that biliary ES lowers the pancreatic intraductal pressure.…”

Section: Endoscopic Sphincterotomy (Es)mentioning

confidence: 96%

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Pancreatits after endoscopic retrograde cholangio-pancreatography

Aziz

Lehman

2007

WJG

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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 nonselected 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 stratification 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.© 2007 The WJG Press. All rights reserved.Key words: Endoscopic retrograde cholangiopancreatography; Post-ERCP pancreatitis Abdel Aziz AM, Lehman GA. Pacreatitis after endoscopic r e t r o g r a d e c h o l a n g i o -p a n c r e a t o g r a p h y . W o r l d J

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Section: Pathogenesismentioning

confidence: 81%

Section: Endoscopic Sphincterotomy (Es)mentioning

confidence: 96%

Pancreatits after endoscopic retrograde cholangio-pancreatography

Aziz

Lehman

2007

WJG

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“…A combination of several technical and patient factors may play a role in the onset of pancreatic injury after ERCP (11,12). Important technical factors include papillary trauma and edema caused by repeated probing with a cannula or guide wire (especially in patients where biliary or pancreatic cannulation is difficult), pancreatic sphincterotomy, precut sphincterotomy, and balloon dilation of the biliary sphincter.…”

Section: Discussionmentioning

confidence: 99%

Clinical trial of gabexate in the prophylaxis of post-endoscopic retrograde cholangiopancreatography pancreatitis

Xiong

Wu²,

Zhang³

et al. 2006

Braz J Med Biol Res

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The objective of the present study was to determine the efficacy of prophylactic administration of gabexate for the prevention of postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis, hyperamylasemia and pancreatic pain. Patients scheduled for ERCP were randomized into two groups in a double-blind manner: the patients in the gabexate group were treated with continuous intravenous infusion of 300 mg gabexate dissolved in 500 mL Ringer's solution at 111 mL/h, starting 30 min before the endoscopic maneuvers and continuing up to 4 h after them; placebo group patients were treated only with Ringer's solution also starting 30 min before the endoscopic maneuvers and continuing up to 4 h. Data for 193 patients were analyzed. The incidence of post-ERCP pancreatitis was 3 patients (3.1%) in the gabexate group and 10 (10.5%) in the placebo group (P = 0.040). The incidence of hyperamylasemia was 33 patients (33.7%) in the gabexate group and 42 (43.7%) in the placebo group (P = 0.133). The incidence of pancreatic pain was 15 patients (15.3%) in the gabexate group and 28 (29.5%) in the placebo group (P = 0.018). The results suggest that a 4.5-h infusion of gabexate (for a total of 300 mg) could prevent post-ERCP pancreatitis and pancreatic pain.

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“…Interestingly, bleeding was not more frequent under heparin, but only under a combination of heparin and antiplatelet therapy (p=0.007) -contrary to the results of Akashi et al and Amelsberg et al [31,32]. However it must be stated that the number of patients with antiplatelet and heparin therapy (five patients) was low.…”

Section: Discussionmentioning

confidence: 72%

Quality assurance of sphincterotomy: A prospective single-centre survey

et al. 2011

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AbstractQuality assurance becomes an increasingly important part of clinical medicine and of the field of endoscopy. Endoscopic sphincterotomy is associated with a fairly high complication rate. We aimed to assess our quality of sphincterotomy for benchmarking by using a prospective electronic database registry, and to identify potential risk factors for post-interventional complications. Over 2 years, 471 sphincterotomies were performed in a single tertiary referral centre. Patient- and procedure-related variables were prospectively recorded with the support of a multi-centre international sphincterotomy registry. Multivariate analysis was performed. The overall post-interventional complication rate was 9.3%. Pancreatitis happened in 5.5%, bleeding in 2.1%, perforation in 1.3%, and cholangitis in 0.4%. In the multivariate analysis following variables remained highly significant and predictive for complications: ‘papilla only in lateral view’ (p=0.001), antiplatelet therapy (p=0.024), and opacification with contrast up to the pancreatic tail (p=0.001). The primary success rate of sphincterotomy was 95.1%. The rate of post-interventional pancreatitis did not differ significantly regardless of the presence of prophylactic pancreatic stent (p=0.56). The outcome of sphincterotomy in our centre matches with literature data. The extent of pancreatic duct opacification has an influence on the pancreatitis rate. Prevention of pancreatitis by inserting pancreatic stents is not confirmed.

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Mechanism of pancreatitis caused by ERCP

Cited by 77 publications

References 21 publications

Pancreatits after endoscopic retrograde cholangio-pancreatography

Pancreatits after endoscopic retrograde cholangio-pancreatography

Clinical trial of gabexate in the prophylaxis of post-endoscopic retrograde cholangiopancreatography pancreatitis

Quality assurance of sphincterotomy: A prospective single-centre survey

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