Nisan 2010
Karaciger sirozu olan hastalarda endoskopik retrograd kolanjiopankreatografi uygulanmasi
Endoscopic retrograde cholangiopancreatography in patients with liver cirrhosis
- Ana Sayfa
- Sayılar
- Nisan 2010
- Karaciger sirozu olan hastalarda endoskopik retrograd kolanjiopankreatografi uygulanmasi...
Özet
Giris ve Amaç: Sirotik hastalarda biliyer hastaliklarda cerrahi disinda alternatif olarak endoskopik retrograd kolanjiyopankreatografinin zaman zaman yapilabilmesi gerekmektedir. Bu tür hastalarda endoskopik retrograd kolanjiyopankreatografi sirasinda yapilacak sfinkterotominin endoskopik sfinkterotomi kanamasindan korkulmaktadir. Bu çalisma klinigimizde karaciger sirozlu hastalara yapilan endoskopik retrograd kolanjiyopankreatografinin endikasyonlarini ve sonuçlarini tartismak amaciyla yapilmistir. Gereç ve Yöntem: 11 hastaya (5 Kadin, 6 Erkek), (Child-pugh sinif A, 2; B, 5; C, 4 kisi) Haziran 2005-Eylül 2008 tarihleri arasinda endoskopik retrograd kolanjiyopankreatografi yapilmistir. Islem öncesi her hastaya antibiyotik profilaksisi yapilmis ve INR degerleri 1.5'in altina çekilmeye çalisilmistir. Tüm hastalara Blended cut-koagülasyon (25 watt/15 watt) tercih edilmistir. Bulgular: On hastada endoskopik sfinkterotomi yapildi, 2 tasli hastada ilave balon dilatasyonu yapildi. Tasi olan 5 hastanin hepsinden taslar çikartildi Bir hastada endoskopik sfinkterotomi yapilmadan stent takildi. Child?Pugh sinif C ve malign biliyer darligi olan bir hastada islem sirasinda baslayan özofagus varis kanamasi disinda endoskopik retrograd kolanjiyopankreatografi islemi ile iliskili komplikasyon izlenmedi. Bu kanama da skleroterapi ile durduruldu. Endoskopik sfinkterotomi yerinde kanama ve pankreatit gözlenmedi. Sonuç: Sirotik hastalarda endoskopik sfinkterotomi koledokolitiazis ve malign biliyer darlikda güvenli ve etkili bir sekilde kullanilmaktadir.
Abstract
Background and Aims: Cirrhotic patients with biliary disease may sometimes require endoscopic retrograde cholangiopancreatography as an alternative to surgery. Endoscopic retrograde cholangiopancreatography in such patients runs the risk of bleeding after sphincterotomy. This study was undertaken in our clinic with the aim of discussing the indications and outcome of endoscopic retrograde cholangiopancreatography in cirrhotic patients. Materials and Methods: Eleven patients (5 female, 6 male) with cirrhosis (Child-Pugh Class A, 2; B, 5; C, 4 patients) underwent endoscopic retrograde cholangiopancreatography between June 2005 and September 2008. Prior to each procedure, antibiotic prophylaxis was given, and attempts were made to maintain an international normalized ratio of less than 1.5. For all patients, blended cut-coagulation (25 watt/15 watt) was preferred. Results: Sphincterotomy was performed in 10 patients, while balloon dilatation was reserved for 2 patients with stones. Stones were successfully extracted in all 5 patients with choledocholithiasis. One of the patients with ChildPugh Class C cirrhosis, who had a malignant biliary stricture, started bleeding from esophageal varices, this being the only endoscopic retrograde cholangiopancreatography-related complication encountered in all patients. Hemostasis in this case was achieved by sclerotherapy. No bleeding from the sphincterotomy site or pancreatitis was observed in any of the patients. Conclusions: Sphincterotomy for choledocholithiasis and malignant biliary strictures is safe and effective, even in cirrhotic patients.
