Servicio de Aparato Digestivo, Hospital Clínico Universitario de Valladolid, Valladolid, España.
Servicio de Aparato Digestivo, Hospital Clínico Universitario de Valladolid, Valladolid, España.
Gastroenterol Hepatol. 2021 Jan;44(1):20-26. doi: 10.1016/j.gastrohep.2020.03.014. Epub 2020 Jul 14.
Different measures are recommended to reduce pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP). We conducted a study in patients with ERCP treated with rectal diclofenac or lactated Ringer's solution, or both interventions, to assess whether there is a decrease in the number of cases of post-ERCP pancreatitis.
A mixed cohort study involving 1,896 patients from 2009 to 2018. Up to June 2012 without treatment (Group I). Subsequently, 100mg of rectal diclofenac (Group II). Since 2016, lactated Ringer's solution 200ml/hour during the procedure and 4hours after it, in addition to 500ml over 30minutes when the pancreas was cannulated (Group III). Since 2017, lactated Ringer's solution plus Diclofenac (Group IV). There were 725 patients in group I, and 530, 227 and 414 patients in groups II, III and IV, respectively. Factors predisposing to post-ERCP pancreatitis and post-ERCP pancreatitis cases that were defined by consensus criteria have been collected.
There were 65 cases of post-ERCP pancreatitis (3.4%); 2.9%, 3.4%, 3.1% and 4.3% in groups I, II, III and IV, respectively (P=.640). In group I, there was 4.2% of post-ERCP pancreatitis in naïve papillae and 4%, 4.9% and 6.3% in groups II, III and IV, respectively (P=.585). The severity of post-ERCP pancreatitis and adverse effects were similar in all groups. 38.4% were high-risk patients. There were also no differences in post-ERCP pancreatitis in this group (P=.501).
In this work, no benefit was obtained with diclofenac plus hydration in reducing the number and severity of cases of post-ERCP pancreatitis nor with the other prophylactic measures.
内镜逆行胰胆管造影（ERCP）后推荐使用不同的措施来降低胰腺炎的发生率。我们对接受直肠双氯芬酸或乳酸林格氏液或两种干预措施治疗的 ERCP 患者进行了一项研究，以评估是否可以减少 ERCP 后胰腺炎的发生。
这是一项从 2009 年至 2018 年纳入了 1896 例患者的混合队列研究。在 2012 年 6 月之前没有治疗（I 组）。随后，直肠给予 100mg 双氯芬酸（II 组）。自 2016 年以来，在手术期间和术后 4 小时内每小时给予 200ml 乳酸林格氏液，并在胰管插管时给予 30 分钟内给予 500ml（III 组）。自 2017 年以来，给予乳酸林格氏液加双氯芬酸（IV 组）。I 组有 725 例患者，II、III 和 IV 组分别有 530、227 和 414 例患者。收集了易患 ERCP 后胰腺炎的因素和符合共识标准的 ERCP 后胰腺炎病例。
有 65 例 ERCP 后胰腺炎（3.4%）；I、II、III 和 IV 组分别为 2.9%、3.4%、3.1%和 4.3%（P=.640）。I 组中，未接受治疗的乳头有 4.2%发生 ERCP 后胰腺炎，II、III 和 IV 组分别为 4%、4.9%和 6.3%（P=.585）。所有组的 ERCP 后胰腺炎严重程度和不良事件均相似。38.4%为高危患者。在该组中，ERCP 后胰腺炎也没有差异（P=.501）。
在这项工作中，直肠给予双氯芬酸加补液并不能减少 ERCP 后胰腺炎的发生数量和严重程度，其他预防措施也没有效果。
