预防 ERCP 后胰腺炎的新兴疗法。
Emerging Therapies to Prevent Post-ERCP Pancreatitis.
机构信息
Division of Gastroenterology and Hepatology, University of California San Francisco, 513 Parnassus Avenue, S-357, Box 0538, San Francisco, CA, 94143-0538, USA.
Gastroenterology Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
出版信息
Curr Gastroenterol Rep. 2020 Nov 13;22(12):59. doi: 10.1007/s11894-020-00796-w.
PURPOSE OF REVIEW
The aim of this review is to evaluate emerging, novel therapies for the prevention of post-ERCP pancreatitis.
RECENT FINDINGS
Rectal indomethacin reduces the risk of pancreatitis in low- and average-risk patients, who comprise the majority of patients undergoing ERCP. An 8-h protocol of aggressive lactated Ringer's reduces the risk of pancreatitis in average-risk patients. Sublingual nitrate may provide additional benefit to rectal NSAIDs in preventing PEP. A tacrolimus trough > 2.5 ng/mL was recently shown to be associated with a lower risk of PEP in liver transplant patients undergoing ERCP. Routine usage of rectal indomethacin in all patients undergoing ERCP reduces the risk of PEP. Pancreatic-duct stents reduce the risk of PEP in high-risk patients. There is emerging data that aggressive hydration with lactated Ringer's and nitrates may further reduce PEP. Tacrolimus is a promising potential agent to prevent PEP but needs further clinical study.
目的综述
本综述旨在评估预防内镜逆行胰胆管造影（ERCP）后胰腺炎的新兴新型疗法。
最近的发现
直肠吲哚美辛可降低低危和中危患者发生胰腺炎的风险，而这些患者构成了接受 ERCP 的大多数患者。8 小时强化乳酸林格氏液方案可降低中危患者发生胰腺炎的风险。舌下硝酸盐可能会为直肠 NSAIDs 预防 PEP 提供额外的益处。最近的研究表明，肝移植患者 ERCP 时，他克莫司谷值 > 2.5ng/mL 与 PEP 风险降低相关。在所有接受 ERCP 的患者中常规使用直肠吲哚美辛可降低 PEP 的风险。胰腺管支架可降低高危患者发生 PEP 的风险。有新数据表明，用乳酸林格氏液和硝酸盐进行积极水化可能会进一步降低 PEP 的发生。他克莫司是一种有前途的预防 PEP 的潜在药物，但需要进一步的临床研究。
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