Aralik 2022
Endoskopik retrograd kolanjiyopankreatografi sonrasi pankreatitin önlenmesinde majör papillaya dogrudan epinefrin püskürtme yönteminin degerlendirilmesi
Evaluation of direct epinephrine injection into the major papilla in the prevention of post ERCP pancreatitis
- Ana Sayfa
- Sayılar
- Aralik 2022
- Endoskopik retrograd kolanjiyopankreatografi sonrasi pankreatitin önlenmesinde majör papillaya dogrudan epinefrin püskürtme yönteminin degerlendirilme...
Erzurum Bölge Egitim ve Arastirma Hastanesi, 2Gastroenteroloji Klinigi, Erzurum
Özet
Giris ve Amaç: Akut pankreatit, endoskopik retrograd kolanjiyopankreatografinin en yaygin komplikasyonudur. Dikkate deger morbidite vemortalite oranlarina sahiptir. Bu çalismanin amaci, tek basina lokal epinefrin uygulamasinin endoskopik retrograd kolanjiyopankreatografi sonrasipankreatit sikligini ve siddetini azaltmadaki etkisini arastirmaktir. Gereç ve Yöntem: Endoskopik retrograd kolanjiyopankreatografi yapilan 979hastanin verileri retrospektif olarak degerlendirildi. Yas, cinsiyet, endoskopik retrograd kolanjiyopankreatografi endikasyonlari, teknigi, endoskopikretrograd kolanjiyopankreatografi sonrasi pankreatit riskini artiran durumlar, endoskopik retrograd kolanjiyopankreatografi sonrasi pankreatitvarligi ve siddeti, serum amilaz, lökosit ve C-reaktif protein seviyeleri (öncesi ve sonrasi) kaydedildi. Veriler sadece lokal epinefrin profilaksisi alan473 hasta ve almayan 506 hasta olmak üzere iki grup arasinda karsilastirildi. Bulgular: Tüm hastalar arasinda endoskopik retrograd kolanjiyopankreatografi sonrasi pankreatit orani %6.8, yüksek riskli hasta grubunda ise %13.6 olarak saptandi. Lokal epinefrin profilaksisi alan grupta,almayan gruba göre endoskopik retrograd kolanjiyopankreatografi sonrasi pankreatit daha az görüldü (%9.1’e karsi %4.4; p = 0.004). Epinefringrubunda endoskopik retrograd kolanjiyopankreatografi sonrasi amilaz, lökosit ve C-reaktif protein düzeyleri epinefrin almayan gruba göre anlamliolarak düsük saptandi (p = 0.001, p = 0.004, p = 0.001). Epinefrin grubunda daha az siklikla siddetli ve orta derecede siddetli pankreatit görüldü(p = 0.003). Yüksek riskli hasta grubunda lokal epinefrin irrigasyonunun endoskopik retrograd kolanjiyopankreatografi sonrasi pankreatit oraninidüsürdügü gözlendi (%18.9’a karsi %7.9; p = 0.002). Sonuç: Majör papillaya direkt püskürtme yöntemi ile epinefrin irrigasyonu endoskopik retrograd kolanjiyopankreatografi sonrasi pankreatitin önlenmesinde uygulamasi kolay, güvenli ve ümit verici bir yöntemdir. Etkinligini arastirmak içingenis popülasyonlarla daha fazla çalismaya ihtiyaç vardir.
Abstract
Background and Aims: Acute pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography, and has remarkable rates of morbidity and mortality. The aim of this study is to investigate the effect of local epinephrine administration alone in reducing the frequency and severity of post-endoscopic retrograde cholangiopancreatography pancreatitis. Materials and Methods: The data of 979 patients who underwent endoscopic retrograde cholangiopancreatography were evaluated retrospectively. Age, gender, indications for endoscopic retrograde cholangiopancreatography procedure, technique, conditions that increase the risk of post-endoscopic retrograde cholangiopancreatography pancreatitis, presence of post-endoscopic retrograde cholangiopancreatography pancreatitis and it’s severity, serum amylase, leukocyte and C-reactive protein levels (before and after endoscopic retrograde cholangiopancreatography) were recorded. The data were compared between two groups as 473 patients who received only local epinephrine prophylaxis and 506 patients that did not. Results: Post-endoscopic retrograde cholangiopancreatography pancreatitis rate was 6.8% in all patients and 13.6% in patients with high risk. Post-endoscopic retrograde cholangiopancreatography pancreatitis was observed less frequently in the group that received local epinephrine prophylaxis when compared to the group that did not (9.1% vs 4.4%; p = 0.004). Post-endoscopic retrograde cholangiopancreatography amylase, leukocyte and C-reactive protein levels were significantly lower in the epinephrine group when compared to the null group (p = 0.001, p = 0.004, p = 0.001). Less severe and moderate pancreatitis was observed in the epinephrine group (p = 0.003). Local epinephrine irrigation was observed to reduce the rate of post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with high risk (18.9% vs 7.9%; p = 0.002). Conclusion: Epinephrine irrigation with direct spraying method to major papillae is an easy-to-apply, safe and promising method in prevention of post- endoscopic retrograde cholangiopancreatography pancreatitis. Further studies with large populations are needed to investigate its effectiveness
