Kwanngern Kris, Tiyapattanaputi Prawes, Wanitpukdeedecha Mongkol, Navicharern Patpong
Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
J Med Assoc Thai. 2005 Sep;88 Suppl 4:S42-5.
Acute pancreatitis is one of the complications after Endoscopic retrograde cholangio pancreatography (ERCP) and it could be fatal. Several drugs were used to prevent or decrease this complication. Corticosteroid is one of the medications which may have such potential. It is affordable and available everywhere.
To compare the incidence of post-ERCP pancreatitis in patients receiving single dose corticosteroid prior to the procedure with that of the control group .
A prospective randomized controlled double-blinded study.
A total of 120 patients were randomized to receive either intravenous hydrocortisone 100 mg. or normal saline 1 hour prior to the procedure. The serum amylase levels were recorded 4 and 24 hours after the procedure. Abdominal pain and back pain were also recorded. Patients were diagnosed as having post-ERCP pancreatitis if ones had new or worsened epigastric pain with or without radiation to the back combined with elevation of serum amylase more than 2.5 times the upper limit.
The overall incidence of pancreatitis was 6.67% with 1.64% in the study group compared with 11.86% in the control group (p = 0.031). The groups were similar with regard to age, gender, type of procedure performed (diagnostic or therapeutic), difficulty of cannulation, concentration of contrast media and pre operative amylase level.
The results of the present trial indicate that hydrocortisone could reduce the risk of post-ERCP pancreatitis.
急性胰腺炎是内镜逆行胰胆管造影术（ERCP）后的并发症之一，可能会致命。有几种药物被用于预防或减少这种并发症。皮质类固醇是可能具有这种潜力的药物之一。它价格低廉且随处可得。
比较术前接受单剂量皮质类固醇治疗的患者与对照组患者ERCP术后胰腺炎的发生率。
一项前瞻性随机对照双盲研究。
总共120例患者被随机分为两组，一组在手术前1小时静脉注射100毫克氢化可的松，另一组注射生理盐水。在手术后4小时和24小时记录血清淀粉酶水平。同时记录腹痛和背痛情况。如果患者出现新的或加重的上腹部疼痛，伴有或不伴有背部放射痛，且血清淀粉酶升高超过上限的2.5倍，则诊断为ERCP术后胰腺炎。
胰腺炎的总体发生率为6.67%，研究组为1.64%，对照组为11.86%（p = 0.031）。两组在年龄、性别、手术类型（诊断性或治疗性）、插管难度、造影剂浓度和术前淀粉酶水平方面相似。
本试验结果表明，氢化可的松可降低ERCP术后胰腺炎的风险。
