This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dong Wang, Zhao-Shen Li, Wen-Jun Zhang, Xue Pan, Zhen-Xing Sun, Xiao-Ping Zou, Department of Gastroenterology, Changhai Hospital, Second Military Medical University, 200433, Shanghai, China
Corresponding author: Dr. Dong Wang, Department of Gastroenterology, Changhai Hospital, Second Military Medical University, 200433, Shanghai, China. wangdonglyz@hotmail.com
Received: December 23, 2002 Revised: December 30, 2002 Accepted: January 8, 2003 Published online: October 15, 2003
AIM
To evaluate the value and safety of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic treatment in acute biliary pancreatitis.
METHODS
Ninety-one patients with acute biliary pancreatitis including 13 patients with severe acute biliary pancreatitis in the ERCP group underwent ERCP and endoscopic therapy. 15 patients with severe acute biliary pancreatitis were not treated by either surgery, endoscopy or early ERCP in the control group. Etiological factors, therapeutic effects and complications were observed in all the patients of the two groups.
RESULTS
In ERCP group, ERCP showed biliary tract disease in 56 cases, common bile duct stones in 26, cholecyst stone in 17, microcholelith in 4, cholangitis in 9, larger diverticula around the papilla in 3, papillitis in 5, pancreatic diverticulum in 2, and normal in 25. 46 cases of biliary tract disease were treated by endoscopy including papillosphincterotomy, endoscopic nasal biliary drainage and endoscopic dilatation of the accessory papilla. There were no significant differences in the recovery days of serum amylase back to normal between ERCP group (3.4±1.6 d) and control group (4.5±2.8 d), but the mean days of disappearance of abdominal pain (4.4±2.0 d), fever (5.0±3.4 d), abnormal white blood cell count (6.5±5.4 d) and hospitalization (21.9±8.4 d) were significantly shorter in the ERCP group than in the control group (8.4±6.1 d, 16.1±19.0 d, 19.1±19.3 d, 41.3±20.0 d, P<0.05). Complication rate (53.9%) and mortality rate (0%) in ERCP group were lower than those of control group (80.0%, 23.1% P<0.05). 17 cases had early complication (18.7%) in ERCP group. Of them, biliary tract infection occurred in 2 cases (2.2%), retroperitoneal pneumatosis in 1 case (1.1%), bleeding of digestive tract in 1 case (1.1%), deterioriation of pancreatitis in 13 cases. 15 patients were cured by medication treatment. Operations were performed in one patient. One patient died.
CONCLUSION
ERCP and endoscopic therapy are safe and effective for patients with acute pancreatitis.
Key Words: N/A
Citation: Wang D, Li ZS, Zhang WJ, Pan X, Sun ZX, Zou XP. Value and safety of ERCP and endoscopic treatment for acute biliary pancreatitis. Shijie Huaren Xiaohua Zazhi 2003; 11(10): 1550-1553
Shah RJ, Martin SP. Endoscopic retrograde cholangiopancreatography in the diagnosis and management of pancreatic diseases.Curr Gastroenterol Rep. 2000;2:133-145.
[PubMed] [DOI]
Ricci F, Castaldini G, de Manzoni G, Borzellino G, Rodella L, Kind R, Cordiano C. Treatment of gallstone pancreatitis: six-year experience in a single center.World J Surg. 2002;26:85-90.
[PubMed] [DOI]
Mergener K, Baillie J. Endoscopic treatment for acute biliary pancreatitis. When and in whom?Gastroenterol Clin North Am. 1999;28:601-613.
[PubMed] [DOI]
Aly EA, Milne R, Johnson CD. Non-compliance with national guidelines in the management of acute pancreatitis in the United kingdom.Dig Surg. 2002;19:192-198.
[PubMed] [DOI]
Arguedas MR, Dupont AW, Wilcox CM. Where do ERCP, endoscopic ultrasound, magnetic resonance cholangiopancreatography, and intraoperative cholangiography fit in the management of acute biliary pancreatitis? A decision analysis model.Am J Gastroenterol. 2001;96:2892-2899.
[PubMed] [DOI]
Masci E, Toti G, Mariani A, Curioni S, Lomazzi A, Dinelli M, Minoli G, Crosta C, Comin U, Fertitta A. Complications of diagnostic and therapeutic ERCP: a prospective multicenter study.Am J Gastroenterol. 2001;96:417-423.
[PubMed] [DOI]
Barthet M, Desjeux A, Gasmi M, Bellon P, Hoi MT, Salducci J, Grimaud JC. Early reefeding after endoscopic biliary or pancreatic sphincterotomy: a randomized prospective study.Endoscopy. 2002;34:546-550.
[PubMed] [DOI]
Masci E, Toti G, Mariani A, Curioni S, Lomazzi A, Dinelli M, Minoli G, Crosta C, Comin U, Fertitta A. Complications of diagnostic and therapeutic ERCP: a prospective multicenter study.Am J Gastroenterol. 2001;96:417-423.
[PubMed] [DOI]
Rabenstein T, Schneider HT, Bulling D, Nicklas M, Katalinic A, Hahn EG, Martus P, Ell C. Analysis of the risk factors associated with endoscopic sphincterotomy techniques: preliminary results of a prospective study, with emphasis on the reduced risk of acute pancreatitis with low-dose anticoagulation treatment.Endoscopy. 2000;32:10-19.
[PubMed] [DOI]
