Clinical Application of ERCP in Postoperative Pancreatitis Prevention for High-Risk Patients after Endoscopic Duct Stents_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Xun , ZHU Xiaoliang , ZHOU Wence , MENG Wenbo , ZHANG Lei , ZHANG Hui , LI Qiong , PU Xiaojin , CHEN Ying , XU Dongxia.

The Second Department of General Surgery ERCP Treatment Center, The First Hospital of Lanzhou University, Gansu Province Key Laboratory of Digestive Tumors, Lanzhou 730030, ChinaCorresponding Author: LI Xun, E-mail： lxdr21@sohu.com;

Corresponding author：

Keywords：

Pancreatic duct stent; ERCP; Post-ERCP pancreatitis

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Objective　 To explore the clinical application in the prevention of post-ERCP pancreatitis (PEP) for high-risk patients undergoing endoscopic duct stent placement.
Methods 　The clinical data of 112 patients with high-risk PEP between January 2005 and June 2010 in this hospital were analyzed retrospectively. According to stents placement or not, 112 patients were divided into stent placement group (n=52) treated by ERCP and stents placement and non-stent placement group (n=60) treated by ERCP without stent retaining. PEP was diagnosed according to Cotton standard, the incidence rate of PEP was compared between two groups and the high-risk influencing factors were analyzed.
Results 　According to Cotton standard, there were only 3 patients (5.8%) diagnosed PEP in the stent placement group, all symptoms disappeared on 48 h after operation, without a diagnosis for severe acute pancreatitis. There were 9 patients (15.0%) diagnosed PEP in the non-stent placement group, and 2 patients were severe acute pancreatitis, The status was better undergoing fasting, aprotinin, anti-inflammatory, and enteral nutrition supporting treatment. The incidence of PEP was associated with younger women (age ≤45 years), Oddi sphincter dysfunction, and no dilation of bile duct (P lt;0.05).
Conclusion 　It can obviously reduce PEP occurrence in high-risk patients with stent placement.

Citation： LI Xun,ZHU Xiaoliang,ZHOU Wence,MENG Wenbo,ZHANG Lei,ZHANG Hui,LI Qiong,PU Xiaojin,CHEN Ying,XU Dongxia.. Clinical Application of ERCP in Postoperative Pancreatitis Prevention for High-Risk Patients after Endoscopic Duct Stents. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(10): 1006-1009. doi: Copy

1.	李汛, 李玉民, 梁聚民, 等. 端粒酶基因和DNA倍体在良恶性梗阻性黄疸中的表达 [J]. 中国普外基础与临床杂志, 2007; 14(5): 531-532.
2.	苏进根, 王建平, 杨廷燕. 十二指肠镜技术在腹腔镜胆囊切除术前术后的应用经验 [J]. 中国普外基础与临床杂志, 2005; 12(4): 343-345.
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4.	Cotton PB, Lehman G, Vennes J, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus [J]. Gastrointest Endosc, 1991; 37(3): 383-393.
5.	李汛, 朱晓亮, 沈亦萱, 等. 镇静、镇痛麻醉在治疗性ERCP中的安全性评估及应用 [J]. 中国普外基础与临床杂志, 2009; 16(8): 645-648.
6.	徐福涛. 内镜术的镇静与麻醉 [J]. 中华消化内镜杂志, 2002; 19(6): 325-326.
7.	潘小平, 党彤. 胰管支架置入术预防ERCP术后胰腺炎研究进展 [J]. 中国实用内科杂志, 2009; 29(9): 852-853.
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9.	Freeman ML, DiSario JA, Nelson DB, et al. Risk factors for post-ERCP pancreatitis: a prospective, multicenter study [J]. Gastrointest Endosc, 2001; 54(4): 425-434.
10.	Sherman S, Lehman GA. ERCP- and endoscopic sphincterotomy-induced pancreatitis [J]. Pancreas, 1991; 6(3): 350-367.
11.	Bailey AA, Bourke MJ, Williams SJ, et al. A prospective randomized trial of cannulation technique in ERCP: effects on technical success and post-ERCP pancreatitis [J]. Endoscopy, 2008; 40(4): 296-301.
12.	Sherman S, Blaut U, Watkins JL, et al. Does prophylactic administration of corticosteroid reduce the risk and severity of post-ERCP pancreatitis: a randomized, prospective, multicenter study [J]. Gastrointest Endosc, 2003; 58(1): 23-29.
13.	Saad AM, Fogel EL, McHenry L, et al. Pancreatic duct stent placement prevents post-ERCP pancreatitis in patients with suspected sphincter of Oddi dysfunction but normal manometry results [J]. Gastrointest Endosc, 2008; 67(2): 255-261.
14.	Singh P, Das A, Isenberg G, et al. Does prophylactic pancreatic stent placement reduce the risk of post-ERCP acute pancreatitis? A meta-analysis of controlled trials [J]. Gastrointest Endosc, 2004; 60(4): 544-550.
15.	Tarnasky PR, Palesch YY, Cunningham JT, et al. Pancreatic stenting prevents pancreatitis after biliary sphincterotomy in patients with sphincter of Oddi dysfunction [J]. Gastroenterology, 1998; 115(6): 1518-1524.
16.	潘涛, 王一平, 杨锦林, 等. 胰管支架置入术预防内镜逆行胰胆管造影术后胰腺炎的系统评价 [J]. 中国循证医学杂志, 2004; 4(10): 693-699.
17.	Andriulli A, Forlano R, Napolitano G, et al. Pancreatic duct stents in the prophylaxis of pancreatic damage after endoscopic retrograde cholangiopancreatography: a systematic analysis of benefits and associated risks [J]. Digestion, 2007; 75　(2-3): 156-163.

1. 　李汛, 李玉民, 梁聚民, 等. 端粒酶基因和DNA倍体在良恶性梗阻性黄疸中的表达 [J]. 中国普外基础与临床杂志, 2007; 14(5): 531-532.
2. 　苏进根, 王建平, 杨廷燕. 十二指肠镜技术在腹腔镜胆囊切除术前术后的应用经验 [J]. 中国普外基础与临床杂志, 2005; 12(4): 343-345.
3. 　Freeman ML. Prevention of post-ERCP pancreatitis: pharmacologic solution or patient selection and pancreatic stents? [J]. Gastroenterology, 2003; 124(7): 1977-1980.
4. 　Cotton PB, Lehman G, Vennes J, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus [J]. Gastrointest Endosc, 1991; 37(3): 383-393.
5. 　李汛, 朱晓亮, 沈亦萱, 等. 镇静、镇痛麻醉在治疗性ERCP中的安全性评估及应用 [J]. 中国普外基础与临床杂志, 2009; 16(8): 645-648.
6. 　徐福涛. 内镜术的镇静与麻醉 [J]. 中华消化内镜杂志, 2002; 19(6): 325-326.
7. 　潘小平, 党彤. 胰管支架置入术预防ERCP术后胰腺炎研究进展 [J]. 中国实用内科杂志, 2009; 29(9): 852-853.
8. 　Andriulli A, Loperfido S, Napolitano G. Incidence rates of postERCP complications: a systematic survey of prospective studies [J]. Am J Gastroenterol, 2007; 102(8): 1781-1788.
9. 　Freeman ML, DiSario JA, Nelson DB, et al. Risk factors for post-ERCP pancreatitis: a prospective, multicenter study [J]. Gastrointest Endosc, 2001; 54(4): 425-434.
10. 　Sherman S, Lehman GA. ERCP- and endoscopic sphincterotomy-induced pancreatitis [J]. Pancreas, 1991; 6(3): 350-367.
11. 　Bailey AA, Bourke MJ, Williams SJ, et al. A prospective randomized trial of cannulation technique in ERCP: effects on technical success and post-ERCP pancreatitis [J]. Endoscopy, 2008; 40(4): 296-301.
12. 　Sherman S, Blaut U, Watkins JL, et al. Does prophylactic administration of corticosteroid reduce the risk and severity of post-ERCP pancreatitis: a randomized, prospective, multicenter study [J]. Gastrointest Endosc, 2003; 58(1): 23-29.
13. 　Saad AM, Fogel EL, McHenry L, et al. Pancreatic duct stent placement prevents post-ERCP pancreatitis in patients with suspected sphincter of Oddi dysfunction but normal manometry results [J]. Gastrointest Endosc, 2008; 67(2): 255-261.
14. 　Singh P, Das A, Isenberg G, et al. Does prophylactic pancreatic stent placement reduce the risk of post-ERCP acute pancreatitis? A meta-analysis of controlled trials [J]. Gastrointest Endosc, 2004; 60(4): 544-550.
15. 　Tarnasky PR, Palesch YY, Cunningham JT, et al. Pancreatic stenting prevents pancreatitis after biliary sphincterotomy in patients with sphincter of Oddi dysfunction [J]. Gastroenterology, 1998; 115(6): 1518-1524.
16. 　潘涛, 王一平, 杨锦林, 等. 胰管支架置入术预防内镜逆行胰胆管造影术后胰腺炎的系统评价 [J]. 中国循证医学杂志, 2004; 4(10): 693-699.
17. 　Andriulli A, Forlano R, Napolitano G, et al. Pancreatic duct stents in the prophylaxis of pancreatic damage after endoscopic retrograde cholangiopancreatography: a systematic analysis of benefits and associated risks [J]. Digestion, 2007; 75　(2-3): 156-163.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical Application of ERCP in Postoperative Pancreatitis Prevention for High-Risk Patients after Endoscopic Duct Stents

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