Matsubara Hiroshi, Urano Fumihiro, Kinoshita Yuki, Okamura Shozo, Kawashima Hiroki, Goto Hidemi, Hirooka Yoshiki
Hiroshi Matsubara, Fumihiro Urano, Yuki Kinoshita, Shozo Okamura, Department of Gastroenterology, Toyohashi Municipal Hospital, Toyohashi City, Aich Prefecture 441-8570, Japan.
World J Gastrointest Endosc. 2017 Apr 16;9(4):189-195. doi: 10.4253/wjge.v9.i4.189.
To determine the risk factors of severe post endoscopic retrograde cholangiopancreatography pancreatitis (sPEP) and clarify the indication of prophylactic treatments.
At 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.
Forty-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 ( < 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.
Contrast media remaining in the pancreatic duct and the appearance of abdominal pain within three hours after ERCP were risk factors of sPEP.
确定内镜逆行胰胆管造影术后严重胰腺炎(sPEP)的危险因素,并阐明预防性治疗的指征。
2012年5月至2015年12月,我院对1507例患者进行了内镜逆行胰胆管造影(ERCP)。在这些患者中,我们纳入了所有121例被诊断为内镜逆行胰胆管造影术后胰腺炎的患者。对121例被诊断为sPEP的患者中的14例进行了分析。
ERCP完成后,41例患者胰管内有造影剂残留。71例患者在ERCP后3小时内出现腹痛。这些在sPEP患者中存在显著差异(<0.05)。体重指数中位数、ERCP的中位时间、次日血清淀粉酶水平中位数、包括饮酒和吸烟在内的既往史、胰腺炎既往史、Oddi括约肌功能障碍、是否为急诊、ERCP操作的专业程度、Vater乳头附近憩室、是否进行括约肌切开术或乳头球囊扩张、胰管插管、是否使用导管内超声强化以及经乳头活检在sPEP患者中无显著差异。
ERCP后胰管内造影剂残留以及ERCP后3小时内出现腹痛是sPEP的危险因素。