Objective To evaluate the effectiveness and safety of gabexate mesylate in the prevention of post-endoscopic retrograde cholangiopancreatography （ERCP） pancreatitis （PEP）. Methods The literatures and corresponding references of randomized controlled trials （RCT） on gabexate mesylate in the prevention of PEP were searched from Cochrane library （1970 to December 2010），PubMed （1966 to December 2010），EMBASE （1966 to December 2010），and CBM （1978 to December 2010）.Literature screening，data extraction and methodological quality assessment were individually performed by two researchers.The software RevMan 4.2 of Cochrane Collaboration was used for statistical analysis. Results A total of 11 trails involving 3 012 patients were included. Meta analysis showed that high dose （≥1 000 mg）of gabexate mesylate with slow intravenous infusion （≥12 h） could effectively prevent from PEP （OR=0.27，95%CI： 0.11-0.64, P=0.003） and post-ERCP abdominal pain （OR=0.44，95%CI： 0.25-0.79，P=0.005） when compared with placebo. The low dose （≤500 mg） of gabexate mesylate with quick intravenous infusion （≤6.5 h） could not effectively prevent from PEP （OR=0.85, 95%CI： 0.59-1.34, P=0.570），post-ERCP hyperamylasemia （OR=0.86，95%CI： 0.69-1.07，P=0.180），and post-ERCP abdominal pain （OR=0.66，95%CI： 0.32-1.35，P=0.250）.When compared gabexate mesylate with ulinastatin, there was no statistical difference between them in the prevention of PEP （OR=1.57，95%CI： 0.39-6.24，P=0.520） and post-ERCP hyperamylasemia （OR=1.85, 95%CI： 0.83-4.13，P=0.130）. Conclusions The high dose （≥1 000 mg） of gabexate mesylate with slow intravenous infusion （≥12 h） other than low dose （≤500 mg） with quick intravenous infusion （≤6.5 h） is effective to prevent from PEP and post-ERCP abdominal pain，and can also prevent from post-ERCP hyperamylasemia to some extent.The effect which ulinastatin prevents PEP and post-ERCP hyperamylasemia is same to gabexate mesylate.The above conclusions remain to confirm by RCT with large sample and long-term follow-up of high-quality.
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 (Plt;0.05). Conclusion It can obviously reduce PEP occurrence in high-risk patients with stent placement.
Objective To evaluate the effectiveness and safety of somatostatin and the analogue-octreotide in preventing post-ERCP pancreatitis. Methods We searched Cochrane Clinical Trial Register （Issue 1, April, 2004 ）, MEDLINE （1966- April, 2004）, EMBASE （1985- April, 2004）, CBM disc （1970- April, 2004） and The Clinical Trial Register of Chinese Evidence-Based Medicine Center and handsearched the related journals to identify Randomized Controlled Trials （RCT）of somatostatin and octreotide in post-endoscopic retrograde chnlangiopancreatography pancreatitis（PEP）prevention. Systematic review was conducted using the method recommended by The Cochrane Collaboration. Results Thirty-one trials involving 4 728 patients undergoing ERCP were included. Meta-analysis showed that the incidence of post-ERCP pancreatitis [ OR 0.33, 95% CI 0. 20 to 0. 54; P =0. 000 01 ; NNT =13] was significantly reduced by somatostatin. Octreotide could only reduce the incidence of hyperamylasemia [ OR 0. 54, 95% CI 0. 38 to 0. 77 ; P =0. 000 7 ]. The inci- dence of PEP, severe PEP and post-ERCP abdominal pain could not be reduced by octreotide. Conclusions Somatostatin can prevent post-ERCP pancreatitis. Four trials are of high quality in the 12 included studies and the results are consistent with the sensitive-analysis, so it is credible to some extent. However, existing evidence does not support that octreotide can reduce the incidence of PEP, so it is not recommended for this indication. Sensitive-analysis even showed that octreotide could increase the incidence of PEP. Therefore, whether it is necessary to carry out further clinical trials should be considered with caution.
目的探讨晚期恶性梗阻性黄疸减黄、保肝的处理方式。方法回顾性分析我科2008年1月至2009年10月期间收治的80例恶性梗阻性黄疸患者，根据肿瘤部位、患者身体、经济条件等确定无法行根治性手术者，采用不同的减黄术式。结果本组80例患者中，9例行PTCD，42例行PTBS，29例行ERBD。并发症发生情况: PTBS组有15例，ERBD组6例，PTCD组2例。PTCD组的住院时间和住院费用明显低于PTBS组和ERBD组(Plt;0.05)。结论晚期恶性梗阻性黄疸，一经确诊，尽早处理，微创引流减黄是首选方式。
Objective To study the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) and early endoscopic management for acute biliary pancreatitis. Methods Ninety-one patients with acute biliary pancreatitis were divided into ERCP group (46 cases) and control group (45 cases) according to the therapy methods. All patients were given positive conventional treatment, the patients of the ERCP group accepted endoscopic therapy within 48 h after hospitalization. The curative effects of two groups were observed, and the related indexes, such as time of abdominal pain relief, temperature to normal, leukocytes to normal, liver function to normal, average time in hospital, and mortality were compared between two groups. Results Among 46 patients by ERCP diagnosis, there were 27 cases of common duct stone (CDS), 6 cases of cholecystolithiasis, 3 cases of great diverticulum at duodenal papilla side, 4 cases of suppurative cholangitis, 3 cases of stenosis in bile common duct inferior segment and 3 cases of no abnormality. Among 27 cases of CDS, 20 patients had endoscopic sphincterotomy (EST), 4 had duodenal papilla artifistulation, 20 had calculus removed by once basket and aerocyst, and 7 patients with suppurative cholangitis and great stone saccepted EST or macadam after stabilization. The cases of great diverticulum at duodenal papilla side and cases of stenosis in bile common duct inferior segment accepted EST, the cases of suppurative cholangitis accepted endoscopic nasobiliary drainage (ENBD), and all accepted ENBD. The time of abdominal pain relief, temperature to normal, leukocytes to normal, liver function to normal, and the average time in hospital in the ERCP group were significantly shorter than those in the control group (Plt;0.05). The blood amylase to normal time and mortality had no significant differences between two groups (Pgt;0.05). Conclusion The early endoscopic management for patients with acute biliary pancreatitis can clear etiology, reduce the time in hospital and be minimally invasive, safe, and effective.